Provider Demographics
NPI:1376735688
Name:DEHYAR, MARIAM (MD)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:DEHYAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIAM
Other - Middle Name:
Other - Last Name:DEHYAR-POPAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:31588 RAILROAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9468
Mailing Address - Country:US
Mailing Address - Phone:951-471-0888
Mailing Address - Fax:951-471-2965
Practice Address - Street 1:27168 NEWPORT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7383
Practice Address - Country:US
Practice Address - Phone:951-246-3033
Practice Address - Fax:951-246-7373
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102480207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine