Basic Information
| Provider Information | |||||||||
| NPI: | 1578722302 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOLARI | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 255228 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958655228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666810736 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11795 EDUCATION ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956022469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308897470 | ||||||||
| FaxNumber: | 5308897471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2008 | ||||||||
| LastUpdateDate: | 09/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | A126399 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 0101248329 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | A126399 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1578722302 | 05 | VA | MEDICAID | A126399 | 05 | CA | MEDICAID |