Healthcare Provider Details

I. General information

NPI: 1720908148
Provider Name (Legal Business Name): MARYAM K BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 HARVEST PARK DR STE B
BRENTWOOD CA
94513-4058
US

IV. Provider business mailing address

505 E ARNAUDO BLVD APT 524
MOUNTAIN HOUSE CA
95391-8433
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-9057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: