Provider Demographics
NPI:1528147105
Name:SOLTANI, SIMA K (DPM)
Entity type:Individual
Prefix:MRS
First Name:SIMA
Middle Name:K
Last Name:SOLTANI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 BARRANCA PKWY STE 245
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1704
Mailing Address - Country:US
Mailing Address - Phone:949-786-7114
Mailing Address - Fax:949-786-7133
Practice Address - Street 1:4330 BARRANCA PKWY STE 245
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1704
Practice Address - Country:US
Practice Address - Phone:949-786-7114
Practice Address - Fax:949-786-7133
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4063213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E40631Medicaid
CA000E40631Medicaid
CAW15712Medicare ID - Type Unspecified