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General NPI Number Information
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NPI Number | 1396936217
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Entity Type | Individual
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Provider Name | MARYAM ARDALAN MD
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Gender | Female
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 25425 ORCHARD VILLAGE RD STE 270
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City | SANTA CLARITA
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State | CA
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Zip | 91355-2958
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Country | US
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Telephone | 661-260-1282
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Fax | 661-414-8047
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Provider Business Mailing Address
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Address Line | 25425 ORCHARD VILLAGE RD STE 270
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City | SANTA CLARITA
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State | CA
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Zip | 91355-2958
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Country | US
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Telephone | 661-260-1282
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Fax | 661-254-4212
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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 | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | A102198
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A102198
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | A102198
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License Number State | CA
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