Healthcare Provider Details

I. General information

NPI: 1194068304
Provider Name (Legal Business Name): MARYAM ALAMOUTINIA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 HOSPITAL RD 207
NEWPORT BEACH CA
92663-3509
US

IV. Provider business mailing address

351 HOSPITAL RD 207
NEWPORT BEACH CA
92663-3509
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-2800
  • Fax: 949-646-8147
Mailing address:
  • Phone: 949-646-2800
  • Fax: 949-646-8147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number11677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: