Provider Demographics
NPI:1851663744
Name:SEDDIGH TONEKABONI, MARYAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:SEDDIGH TONEKABONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18350 ROSCOE BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4159
Mailing Address - Country:US
Mailing Address - Phone:818-671-1989
Mailing Address - Fax:818-698-0440
Practice Address - Street 1:18350 ROSCOE BLVD STE 307
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4159
Practice Address - Country:US
Practice Address - Phone:818-671-1989
Practice Address - Fax:818-698-0440
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB265442Medicare UPIN