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NPI Code Detail

MEDICARE: MARYAM MOHAMADI

MEDICARE: MARYAM MOHAMADI
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
11223G0001XGeneral Practice Dentistry112185CA

General Provider Information

NPI Number : 1982589222
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYAM MOHAMADI
Provider Business Mailing Address
First Line : 1889 VICENTE DR
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93405-6856
Country : US
Telephone Number : 805-215-4703
Fax Number :
Provider Business Practice Location Address
First Line : 3870 BROAD ST STE 1
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-7172
Country : US
Telephone Number : 805-309-0467
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2025
Last Update Date : 08/06/2025

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Directions to “ MARYAM MOHAMADI ” Practice Location

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