Provider Demographics
NPI:1497931950
Name:BISHARA, MARIAM NESSIEM ZAKI (MD-PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:NESSIEM ZAKI
Last Name:BISHARA
Suffix:
Gender:F
Credentials:MD-PHD
Other - Prefix:
Other - First Name:MARIAM
Other - Middle Name:NZ
Other - Last Name:BISHARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1814 W LINCOLN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6730
Mailing Address - Country:US
Mailing Address - Phone:323-668-7930
Mailing Address - Fax:323-889-7821
Practice Address - Street 1:1814 W LINCOLN AVE STE B
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6730
Practice Address - Country:US
Practice Address - Phone:323-668-7930
Practice Address - Fax:323-889-7821
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14738207R00000X
CAA102845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine