MEDICARE: MARIAM BOKTOR

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	101YS0200X	School Counselor		CA

General Provider Information

NPI Number	:	1821929803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAM BOKTOR

Provider Business Mailing Address
First Line	:	1435 LOGAN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1435 LOGAN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3307
Country	:	US
Telephone Number	:	559-904-1722
Fax Number	:

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

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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Directions to “ MARIAM BOKTOR ” Practice Location

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