Provider Demographics
NPI:1366756785
Name:SOLTANI, SOPHIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SOPHIE
Middle Name:
Last Name:SOLTANI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-2115
Mailing Address - Country:US
Mailing Address - Phone:510-523-4300
Mailing Address - Fax:
Practice Address - Street 1:745 BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2115
Practice Address - Country:US
Practice Address - Phone:510-523-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18056103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist