Healthcare Provider Details

I. General information

NPI: 1699636167
Provider Name (Legal Business Name): EKRAM MUBAREK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 S ARROYO PKWY
PASADENA CA
91105-1930
US

IV. Provider business mailing address

939 BUCHANAN ST APT C
SAN FRANCISCO CA
94102-4161
US

V. Phone/Fax

Practice location:
  • Phone: 323-207-9038
  • Fax:
Mailing address:
  • Phone: 415-837-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: