Provider Demographics
NPI:1174836910
Name:EL-KALAY, MARIAM (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:EL-KALAY
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PALOMAR AIRPORT RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 PALOMAR AIRPORT RD STE 300
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1028
Practice Address - Country:US
Practice Address - Phone:858-381-7721
Practice Address - Fax:858-210-6369
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-10-7058103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst