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General NPI Number Information
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NPI Number | 1093160764
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Entity Type | Individual
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Provider Name | MARYAM SHAMS NP
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Gender | Female
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 8635 FIRESTONE BLVD
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City | DOWNEY
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State | CA
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Zip | 90241-5281
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Country | US
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Telephone | 909-382-0201
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Fax | 909-382-0210
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Provider Business Mailing Address
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Address Line | PO BOX 10818
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City | SAN BERNARDINO
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State | CA
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Zip | 92423-0818
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Country | US
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Telephone | 909-382-0201
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Fax | 909-382-0210
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 95004234
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License Number State | CA
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