Provider Demographics
NPI:1851316707
Name:SAINT MARIAM MEDICAL CLINIC,INC
Entity Type:Organization
Organization Name:SAINT MARIAM MEDICAL CLINIC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANAA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-857-1871
Mailing Address - Street 1:4950 BARRANCA PKWY STE 204
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4687
Mailing Address - Country:US
Mailing Address - Phone:949-857-1871
Mailing Address - Fax:949-857-1879
Practice Address - Street 1:4950 BARRANCA PKWY STE 204
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4687
Practice Address - Country:US
Practice Address - Phone:949-857-1871
Practice Address - Fax:949-857-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA680932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19972Medicare PIN