Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 95004234 | CA |
NPI | 1093160764 |
---|---|
Provider Name | Maryam Shams |
First Address | San Bernardino, CA 92423-0818 |
Second Address | Downey, CA 90241-5281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2016 |
Last Update Date | 29/11/2021 |