Basic Information
| Provider Information | |||||||||
| NPI: | 1245648906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAWABI | ||||||||
| FirstName: | MARIAM | ||||||||
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| Credential: | MA, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 WOOD BARN RD | ||||||||
| Address2: | |||||||||
| City: | LADERA RANCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926941022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494133756 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2200 HARBOR BLVD STE C250 | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926272593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499106767 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2014 | ||||||||
| LastUpdateDate: | 07/25/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-14-16533 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.