Healthcare Provider Details

I. General information

NPI: 1912844598
Provider Name (Legal Business Name): MARIAMA UMEH BAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD BLDG 402
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

3300 W 157TH ST
GARDENA CA
90249-4410
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95333928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: