Provider Demographics
NPI:1508057084
Name:R F PODIATRY CLINIC
Entity Type:Organization
Organization Name:R F PODIATRY CLINIC
Other - Org Name:SIMA K SOLTANI
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIMA
Authorized Official - Middle Name:KALIFEH
Authorized Official - Last Name:SOLTANI
Authorized Official - Suffix:SR
Authorized Official - Credentials:DPM PODIATRIC
Authorized Official - Phone:949-786-7114
Mailing Address - Street 1:33 CREEK RD
Mailing Address - Street 2:#B-200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604
Mailing Address - Country:US
Mailing Address - Phone:949-786-7114
Mailing Address - Fax:949-786-7133
Practice Address - Street 1:33 CREEK RD
Practice Address - Street 2:#B-200
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604
Practice Address - Country:US
Practice Address - Phone:949-786-7114
Practice Address - Fax:949-786-7133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4063213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E40631Medicaid
CAU66235Medicare UPIN
CA5477100001Medicare NSC
CAW15712Medicare PIN