Provider Demographics
NPI:1477717635
Name:SOLTANI, SAMIRA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SAMIRA
Middle Name:
Last Name:SOLTANI
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 1:7920 CARMEL AVE NE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2966
Mailing Address - Country:US
Mailing Address - Phone:505-262-7000
Mailing Address - Fax:505-828-4989
Practice Address - Street 1:11601 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2660
Practice Address - Country:US
Practice Address - Phone:505-207-3421
Practice Address - Fax:505-702-8171
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2008-0024363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant