Provider Demographics
NPI:1255493128
Name:GHALILI, SOLEIMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SOLEIMAN
Middle Name:
Last Name:GHALILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 S SAN PEDRO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-1125
Mailing Address - Country:US
Mailing Address - Phone:213-745-8766
Mailing Address - Fax:
Practice Address - Street 1:2101 S SAN PEDRO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-1125
Practice Address - Country:US
Practice Address - Phone:213-745-8766
Practice Address - Fax:213-745-8704
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41622208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A416220Medicaid