Provider Demographics
NPI:1083183248
Name:EMMONS, MARAL MARIAM
Entity Type:Individual
Prefix:
First Name:MARAL
Middle Name:MARIAM
Last Name:EMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 E DESERT SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-6167
Mailing Address - Country:US
Mailing Address - Phone:702-305-1105
Mailing Address - Fax:
Practice Address - Street 1:1271 E DESERT SPRINGS WAY
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-6167
Practice Address - Country:US
Practice Address - Phone:702-305-1105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician