Provider Demographics
NPI:1003314089
Name:SAM SOLEYMANI APEX IMAGING
Entity Type:Organization
Organization Name:SAM SOLEYMANI APEX IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLEYMANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-304-6566
Mailing Address - Street 1:18003 HARVEST AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5549
Mailing Address - Country:US
Mailing Address - Phone:562-304-6566
Mailing Address - Fax:562-261-2939
Practice Address - Street 1:18003 HARVEST AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5549
Practice Address - Country:US
Practice Address - Phone:562-304-6566
Practice Address - Fax:562-261-2939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53010261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center