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General NPI Number Information
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NPI Number | 1932139615
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Entity Type | Individual
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Provider Name | MARYAM SAMADI-SOLTANI M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 05/07/2020
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Provider Practice Location Address
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Address Line | 4310 ORANGE ST
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City | RIVERSIDE
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State | CA
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Zip | 92501-3829
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Country | US
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Telephone | 951-781-6335
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Fax | 951-208-7244
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Provider Business Mailing Address
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Address Line | 4310 ORANGE ST
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City | RIVERSIDE
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State | CA
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Zip | 92501-3829
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Country | US
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Telephone | 951-781-6335
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Fax | 951-208-7244
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD00046432
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A92838
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License Number State | CA
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