Basic Information
| Provider Information | |||||||||
| NPI: | 1134114663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOLEIMANPOUR | ||||||||
| FirstName: | MEHDI | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60049 | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910666049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266987246 | ||||||||
| FaxNumber: | 6264471058 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 OLD NEWPORT BLVD | ||||||||
| Address2: | SUITE #201 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926634291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499992950 | ||||||||
| FaxNumber: | 9499992943 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 06/01/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35038629S | OH | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | A35230 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00A352300 | 01 | CA | BLUE SHIELD | OTHER | 00A352300 | 05 | CA | MEDICAID |