Provider Demographics
NPI:1033694302
Name:ALHAKIM, MARIAM (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:ALHAKIM
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SUNSET CV
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0834
Mailing Address - Country:US
Mailing Address - Phone:714-514-7220
Mailing Address - Fax:
Practice Address - Street 1:1172 N MACLAY AVE
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-1328
Practice Address - Country:US
Practice Address - Phone:818-898-1388
Practice Address - Fax:818-270-9590
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009868208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics