MEDICARE: PORT MEDICAL ASSOCIATE INC

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	208D00000X	General Practice Physician	FNP39177	CA
2	171100000X	Acupuncturist
3	111N00000X	Chiropractor
4	208D00000X	General Practice Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FNP39177	OTHER	CA	FICTITIOUS NAME PERMIT

General Provider Information

NPI Number	:	1992935639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT MEDICAL ASSOCIATE INC

Provider Business Mailing Address
First Line	:	PO BOX 6200
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806
Country	:	US
Telephone Number	:	562-426-4598
Fax Number	:	562-318-3042

Provider Business Practice Location Address
First Line	:	2530 ATLANTIC AVE STE A
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2741
Country	:	US
Telephone Number	:	562-426-4598
Fax Number	:	562-318-3042

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. KARIM A. SOLIMAN
Credential	:	M.D.
Telephone Number	:	562-426-4598

Provider Enumeration Date	:	07/15/2009
Last Update Date	:	12/18/2013

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Directions to “PORT MEDICAL ASSOCIATE INC ” Practice Location

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