Healthcare Provider Details

I. General information

NPI: 1194714527
Provider Name (Legal Business Name): MOHAMMAD R SOLEIMANPOUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5119 GARFIELD ST
LA MESA CA
91941-5103
US

IV. Provider business mailing address

5119 GARFIELD ST
LA MESA CA
91941-5103
US

V. Phone/Fax

Practice location:
  • Phone: 619-460-4055
  • Fax:
Mailing address:
  • Phone: 619-460-4055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA52296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: