Provider Demographics
NPI:1346548690
Name:SOTOODEH, LAYLA NINA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LAYLA
Middle Name:NINA
Last Name:SOTOODEH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13160 MINDANAO WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6358
Mailing Address - Country:US
Mailing Address - Phone:310-574-0400
Mailing Address - Fax:
Practice Address - Street 1:13160 MINDANAO WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6358
Practice Address - Country:US
Practice Address - Phone:310-574-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21474363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant