Healthcare Provider Details

I. General information

NPI: 1982241154
Provider Name (Legal Business Name): MARAM OTHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 SNELL AVE
SAN JOSE CA
95136-1305
US

IV. Provider business mailing address

3519 HAIG ST
SANTA CLARA CA
95054-2227
US

V. Phone/Fax

Practice location:
  • Phone: 408-618-5265
  • Fax:
Mailing address:
  • Phone: 408-643-1589
  • 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: