MEDICARE: MARIYAM SOORMA

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
1	225400000X	Rehabilitation Practitioner
2	101YM0800X	Mental Health Counselor	119856	CA
3	106H00000X	Marriage & Family Therapist	147224	CA

General Provider Information

NPI Number	:	1730666876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIYAM SOORMA

Provider Business Mailing Address
First Line	:	8750 TOPANGA CANYON BLVD APT 21
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91304-2484
Country	:	US
Telephone Number	:	818-334-7637
Fax Number	:

Provider Business Practice Location Address
First Line	:	8750 TOPANGA CANYON BLVD APT 21
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91304-2484
Country	:	US
Telephone Number	:	818-334-7637
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2018
Last Update Date	:	06/05/2024

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Directions to “ MARIYAM SOORMA ” Practice Location

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