Healthcare Provider Details

I. General information

NPI: 1710591995
Provider Name (Legal Business Name): TARIQ SOLIMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8110 WOODMAN AVE BLDG 5
PANORAMA CITY CA
91402
US

IV. Provider business mailing address

651 ORIZABA AVE
LONG BEACH CA
90814-1325
US

V. Phone/Fax

Practice location:
  • Phone: 818-375-3154
  • Fax:
Mailing address:
  • Phone: 714-599-3702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279E0002X
TaxonomyEmergency Care Registered Respiratory Therapist
License Number23334
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number23334
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number23334
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number23334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: