Healthcare Provider Details

I. General information

NPI: 1053965889
Provider Name (Legal Business Name): MARIYAM-IFTEAM Y. RUFAEL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 GRAND AVE
OAKLAND CA
94610-5057
US

IV. Provider business mailing address

7022 STOCKTON AVE
EL CERRITO CA
94530-2949
US

V. Phone/Fax

Practice location:
  • Phone: 209-292-8708
  • Fax:
Mailing address:
  • Phone: 510-570-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: