Healthcare Provider Details

I. General information

NPI: 1841106457
Provider Name (Legal Business Name): MARYAM MEHMOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARYAM MEHMOOD KANWAL

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10080 N WOLFE RD
CUPERTINO CA
95014-2515
US

IV. Provider business mailing address

100 FIRETHORN ST
MILPITAS CA
95035-2513
US

V. Phone/Fax

Practice location:
  • Phone: 310-344-0755
  • Fax:
Mailing address:
  • Phone: 310-344-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95041208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: