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NPI Code Detail

MEDICARE: MS. MARIAM ANN PAUL MFT

MEDICARE: MS. MARIAM ANN PAUL MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMG15544CA

General Provider Information

NPI Number : 1245567858
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARIAM ANN PAUL MFT
Provider Business Mailing Address
First Line : 17261 GOTHARD ST SPC 61
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92647-5465
Country : US
Telephone Number : 949-735-7171
Fax Number :
Provider Business Practice Location Address
First Line : 1207 E FRUIT ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92701-4206
Country : US
Telephone Number : 714-953-9373
Fax Number : 714-953-7573
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2009
Last Update Date : 11/03/2009

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