=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235086844
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIAH MAIR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2026
-----------------------------------------------------
Last Update Date | 03/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 880 THIRD AVE
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91911-1305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-662-4100
-----------------------------------------------------
Fax | 619-573-6491
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 947 DATE ST
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92101-2859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-623-2831
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 136807
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------