Healthcare Provider Details

I. General information

NPI: 1609188481
Provider Name (Legal Business Name): PROFILES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD SUITE M130
WEST HOLLYWOOD CA
90069-3701
US

IV. Provider business mailing address

PO BOX 7001
TARZANA CA
91357-7001
US

V. Phone/Fax

Practice location:
  • Phone: 310-276-6800
  • Fax: 310-276-6801
Mailing address:
  • Phone: 818-888-7815
  • Fax: 818-715-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA98512
License Number StateCA

VIII. Authorized Official

Name: PEYMAN SOLIEMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-276-6800