Healthcare Provider Details

I. General information

NPI: 1093068330
Provider Name (Legal Business Name): SOLOMON LAKTINEH, M.D. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6624 CHERRY AVE
LONG BEACH CA
90805-1715
US

IV. Provider business mailing address

1040 ELM AVE SUITE 304
LONG BEACH CA
90813-3267
US

V. Phone/Fax

Practice location:
  • Phone: 562-630-2200
  • Fax: 562-630-2209
Mailing address:
  • Phone: 562-624-1111
  • Fax: 562-624-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA50421
License Number StateCA

VIII. Authorized Official

Name: SOLOMON LAKTINEH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-624-1111