Provider Demographics
NPI:1306408950
Name:KARAM, MOURHAF MAHER
Entity Type:Individual
Prefix:
First Name:MOURHAF
Middle Name:MAHER
Last Name:KARAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13711 FOOTHILL BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-3138
Mailing Address - Country:US
Mailing Address - Phone:818-285-9947
Mailing Address - Fax:
Practice Address - Street 1:13711 FOOTHILL BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3138
Practice Address - Country:US
Practice Address - Phone:818-408-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CAPA57185363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant