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Organization
SOUTHERN SOLANO EMERGENCY MEDICAL GROUP, INC
Active
Organization
SOUTHERN SOLANO EMERGENCY MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD D CARVOLTH M.D. (PRESIDENT)
(925) 924-1600
Entity
Organization
Contact information
Practice address
300 HOSPITAL DR, VALLEJO, CA 94589-2574
(925) 924-1600
Mailing address
PO BOX 634719, CINCINNATI, OH 45263-4719
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC2287
MEDICARE RR
CA
05
—
GR0095980
—
CA
01
—
ZZZ09370Z
BS CALIFORNIA
CA
Enumeration date
06/29/2006
Last updated
10/19/2007
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