Healthcare Provider Details

I. General information

NPI: 1073321444
Provider Name (Legal Business Name): MARIAM A. HUSSAIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6699 ALVARADO RD STE 2308
SAN DIEGO CA
92120-5241
US

IV. Provider business mailing address

6010 HIDDEN VALLEY RD STE 200
CARLSBAD CA
92011-4219
US

V. Phone/Fax

Practice location:
  • Phone: 760-631-3000
  • Fax: 760-631-3016
Mailing address:
  • Phone: 760-631-3000
  • Fax: 760-631-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY35561
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35561
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: