Healthcare Provider Details

I. General information

NPI: 1932139615
Provider Name (Legal Business Name): MARYAM SAMADI-SOLTANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARYAM SOLTANI M.D.

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 ORANGE ST
RIVERSIDE CA
92501-3829
US

IV. Provider business mailing address

4310 ORANGE ST
RIVERSIDE CA
92501-3829
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-6335
  • Fax: 951-208-7244
Mailing address:
  • Phone: 951-781-6335
  • Fax: 951-208-7244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00046432
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA92838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: