Healthcare Provider Details

I. General information

NPI: 1972225886
Provider Name (Legal Business Name): ORIYAN MAOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 ALAMO ST STE 103
SIMI VALLEY CA
93063-2188
US

IV. Provider business mailing address

3695 ALAMO ST STE 103
SIMI VALLEY CA
93063-2188
US

V. Phone/Fax

Practice location:
  • Phone: 805-273-8014
  • Fax:
Mailing address:
  • Phone: 805-273-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number130289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: