Provider Demographics
NPI:1205427150
Name:SOULEIMAN, AIDA MARIE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:MARIE
Last Name:SOULEIMAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2887
Mailing Address - Country:US
Mailing Address - Phone:949-413-1955
Mailing Address - Fax:
Practice Address - Street 1:441 E CARSON ST STE K
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-7713
Practice Address - Country:US
Practice Address - Phone:949-413-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014988363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner