Healthcare Provider Details

I. General information

NPI: 1225605215
Provider Name (Legal Business Name): MIRIAM ABDELMESIH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 EUCLID ST
SANTA MONICA CA
90404-3306
US

IV. Provider business mailing address

1235 S ALFRED ST APT 2
LOS ANGELES CA
90035-2545
US

V. Phone/Fax

Practice location:
  • Phone: 310-451-9747
  • Fax:
Mailing address:
  • Phone: 310-954-6784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: