Healthcare Provider Details

I. General information

NPI: 1619893716
Provider Name (Legal Business Name): MARIAM AJMAIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 E HERNDON AVE
FRESNO CA
93720-3303
US

IV. Provider business mailing address

1570 E HERNDON AVE
FRESNO CA
93720-3303
US

V. Phone/Fax

Practice location:
  • Phone: 559-603-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number68613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: