Healthcare Provider Details

I. General information

NPI: 1164371746
Provider Name (Legal Business Name): MARYAM AL SHAIKHLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 HALE PL STE 110
CHULA VISTA CA
91914-3598
US

IV. Provider business mailing address

1210 GREEN GARDEN DR
EL CAJON CA
92021-1303
US

V. Phone/Fax

Practice location:
  • Phone: 619-704-7577
  • Fax: 619-704-7578
Mailing address:
  • Phone: 510-566-6354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: