Healthcare Provider Details

I. General information

NPI: 1437454543
Provider Name (Legal Business Name): SOLOMON LAKTINEH, M.D., A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 ATLANTIC AVE
LONG BEACH CA
90813-4565
US

IV. Provider business mailing address

780 ATLANTIC AVE
LONG BEACH CA
90813-4565
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA50421
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA50421
License Number StateCA

VIII. Authorized Official

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