Provider Demographics
NPI:1013541952
Name:MOMIN, MARIA (SLP, MA-CCC)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:MOMIN
Suffix:
Gender:F
Credentials:SLP, MA-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 S DANIEL WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3124
Mailing Address - Country:US
Mailing Address - Phone:408-324-4723
Mailing Address - Fax:
Practice Address - Street 1:1033 S DANIEL WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3124
Practice Address - Country:US
Practice Address - Phone:408-324-4723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist