Basic Information
| Provider Information | |||||||||
| NPI: | 1518372267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOLTANI | ||||||||
| FirstName: | MARYAM | ||||||||
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| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF CALIFORNIA SAN DIEGO | ||||||||
| Address2: | 200 WEST ARBOR DRIVE | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921038809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197391906 | ||||||||
| FaxNumber: | 6196871067 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 W ARBOR DR | ||||||||
| Address2: | MC 8809 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921039000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192338500 | ||||||||
| FaxNumber: | 6196871067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2014 | ||||||||
| LastUpdateDate: | 06/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A139075 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.