Provider Demographics
NPI:1376619445
Name:SOLTANI, MAHBOBEH M (DC)
Entity Type:Individual
Prefix:
First Name:MAHBOBEH
Middle Name:M
Last Name:SOLTANI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 N E ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1300
Mailing Address - Country:US
Mailing Address - Phone:909-888-9944
Mailing Address - Fax:909-888-4485
Practice Address - Street 1:599 N E ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1300
Practice Address - Country:US
Practice Address - Phone:909-888-9944
Practice Address - Fax:909-888-4485
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor