Provider Demographics
NPI:1437454543
Name:SOLOMON LAKTINEH, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SOLOMON LAKTINEH, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKTINEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-624-1111
Mailing Address - Street 1:780 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4565
Mailing Address - Country:US
Mailing Address - Phone:562-624-1111
Mailing Address - Fax:562-624-1115
Practice Address - Street 1:780 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4565
Practice Address - Country:US
Practice Address - Phone:562-624-1111
Practice Address - Fax:562-624-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50421208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50421Medicaid