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General NPI Number Information
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NPI Number | 1992332639
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Entity Type | Individual
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Provider Name | MIRIAM FAHIM
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Gender | Female
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 9850 GENESEE AVE STE 600
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City | LA JOLLA
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State | CA
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Zip | 92037-1207
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Country | US
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Telephone | 858-554-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 10790 RANCHO BERNARDO RD
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City | SAN DIEGO
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State | CA
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Zip | 92127-5705
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Country | US
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Telephone | 858-554-7700
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | A193694
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License Number State | CA
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