Basic Information
| Provider Information | |||||||||
| NPI: | 1851450787 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAMAEI-TOUSI | ||||||||
| FirstName: | MARYAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4455 COLBATH AVE | ||||||||
| Address2: | APARTMENT 208 | ||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914233536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185011436 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7621 CANOGA AVE | ||||||||
| Address2: | |||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913044912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185986900 | ||||||||
| FaxNumber: | 8185986977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.