Healthcare Provider Details

I. General information

NPI: 1295421097
Provider Name (Legal Business Name): ALBERT L. SOULEMA, DDS, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 COUNTRY CLUB DR STE C
SIMI VALLEY CA
93065-7696
US

IV. Provider business mailing address

16632 DIAMANTE DR
ENCINO CA
91436-4148
US

V. Phone/Fax

Practice location:
  • Phone: 818-968-1491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT SOULEMA
Title or Position: CEO
Credential: DDS
Phone: 818-968-1491