Healthcare Provider Details

I. General information

NPI: 1275156853
Provider Name (Legal Business Name): MARIAM ATTAWIA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 ADELINE ST STE 280
BERKELEY CA
94703-2580
US

IV. Provider business mailing address

21100 GARY DR APT 203
CASTRO VALLEY CA
94546-6110
US

V. Phone/Fax

Practice location:
  • Phone: 510-981-4100
  • Fax:
Mailing address:
  • Phone: 925-353-7513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: