MEDICARE: MYRIAM SOLER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	25332	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	513321	OTHER	CA	DENTICAL PROVIDER #

General Provider Information

NPI Number	:	1013127000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRIAM SOLER DDS

Provider Business Mailing Address
First Line	:	3127 LOS FELIZ BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1506
Country	:	US
Telephone Number	:	323-662-3179
Fax Number	:

Provider Business Practice Location Address
First Line	:	3127 LOS FELIZ BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1506
Country	:	US
Telephone Number	:	323-662-3179
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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