Provider Demographics
NPI:1730586975
Name:SOLOMON, JAMIE (RD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:POLLAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2702 N 3RD ST
Mailing Address - Street 2:STE 4020
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1130
Mailing Address - Country:US
Mailing Address - Phone:602-323-3345
Mailing Address - Fax:602-323-3399
Practice Address - Street 1:635 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6551
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:602-243-1235
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86036064133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86036064OtherLICENSE