Provider Demographics
NPI:1801154067
Name:SOLEIMANI, SHAHRAM (DC)
Entity type:Individual
Prefix:DR
First Name:SHAHRAM
Middle Name:
Last Name:SOLEIMANI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9388 TWIN TRAILS DR
Mailing Address - Street 2:UNIT 203
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2672
Mailing Address - Country:US
Mailing Address - Phone:818-424-3509
Mailing Address - Fax:
Practice Address - Street 1:7301 GIRARD AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5125
Practice Address - Country:US
Practice Address - Phone:818-424-3509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor