Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 45412 | CA |
NPI | 1134213770 |
---|---|
Provider Name | Dr. Pooneh Soltani |
First Address | Playa Del Rey, CA 90293 |
Second Address | Long Beach, CA 90293 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |