Provider Demographics
NPI:1518372267
Name:SOLTANI, MARYAM (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:SOLTANI
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF CALIFORNIA SAN DIEGO
Mailing Address - Street 2:200 WEST ARBOR DRIVE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8809
Mailing Address - Country:US
Mailing Address - Phone:619-739-1906
Mailing Address - Fax:619-687-1067
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:MC 8809
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:619-233-8500
Practice Address - Fax:619-687-1067
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1390752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry