Provider Demographics
NPI:1053504464
Name:HAJIMOOSA, MARIAM (MA, MFT)
Entity Type:Individual
Prefix:MISS
First Name:MARIAM
Middle Name:
Last Name:HAJIMOOSA
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9655 GRANITE RIDGE DR
Mailing Address - Street 2:#600
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2674
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9655 GRANITE RIDGE DR
Practice Address - Street 2:#600
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2674
Practice Address - Country:US
Practice Address - Phone:858-571-8295
Practice Address - Fax:858-278-8911
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48658106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist