Provider Demographics
NPI:1992935639
Name:PORT MEDICAL ASSOCIATE INC
Entity type:Organization
Organization Name:PORT MEDICAL ASSOCIATE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-426-4598
Mailing Address - Street 1:PO BOX 6200
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:562-426-4598
Mailing Address - Fax:562-318-3042
Practice Address - Street 1:2530 ATLANTIC AVE STE A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2741
Practice Address - Country:US
Practice Address - Phone:562-426-4598
Practice Address - Fax:562-318-3042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 171100000X, 208D00000X
CAFNP39177208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFNP39177OtherFICTITIOUS NAME PERMIT