Basic Information
| Provider Information | |||||||||
| NPI: | 1447679865 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOLEYMANI | ||||||||
| FirstName: | TEO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5767 W CENTURY BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900455631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103018771 | ||||||||
| FaxNumber: | 3103018751 | ||||||||
| Practice Location | |||||||||
| Address1: | 514 N PROSPECT AVE | ||||||||
| Address2: | |||||||||
| City: | REDONDO BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902773036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109378555 | ||||||||
| FaxNumber: | 3109378556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2014 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0900X | A144007 | CA | N | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 2082S0099X | A144007 | CA | N | Allopathic & Osteopathic Physicians | Plastic Surgery | Plastic Surgery Within the Head and Neck | 2086X0206X | A144007 | CA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | 207N00000X | A144007 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology | 390200000X | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.