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NPI Code Detail

MEDICARE: ZAMZAM JAMA

MEDICARE: ZAMZAM JAMA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1215785365
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZAMZAM JAMA
Provider Business Mailing Address
First Line : 2812 FAIRVIEW AVE N
Second Line :
City : ROSEVILLE
State : MN
Zip : 55113-1308
Country : US
Telephone Number : 612-345-7306
Fax Number : 612-587-1103
Provider Business Practice Location Address
First Line : 2812 FAIRVIEW AVE N
Second Line :
City : ROSEVILLE
State : MN
Zip : 55113-1308
Country : US
Telephone Number : 612-345-7306
Fax Number : 612-587-1103
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2024
Last Update Date : 05/13/2024

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Directions to “ ZAMZAM JAMA ” Practice Location

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