Provider Demographics
NPI:1679529093
Name:SOUMAH, NBALIA MARIE-ANGE (DO)
Entity Type:Individual
Prefix:
First Name:NBALIA
Middle Name:MARIE-ANGE
Last Name:SOUMAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5691
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:11333 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1116
Practice Address - Country:US
Practice Address - Phone:818-837-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8794207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0020A87940Medicaid
CAZZT40394FMedicaid
CARHM08609FMedicaid
CA050394OtherBLUE CROSS
CA95-1683892OtherOTHER INSURANCE
CARHM08608FMedicaid
CARHM18553HMedicaid
CAW20A8794AMedicare ID - Type UnspecifiedPPIN
CA0020A87940Medicaid
CAZZT40394FMedicaid
CAW20A8794EMedicare ID - Type UnspecifiedPPIN
CA058553Medicare ID - Type UnspecifiedRH MEDICARE
CA058609Medicare ID - Type UnspecifiedRH MEDICARE
CA95-1683892OtherOTHER INSURANCE
CAW20A8794FMedicare ID - Type UnspecifiedPPIN
CAW20A8794CMedicare ID - Type UnspecifiedPPIN
CA058608Medicare ID - Type UnspecifiedRH MEDICARE
CAW20A8794GMedicare ID - Type UnspecifiedPPIN
CARHM18553HMedicaid