Provider Demographics
NPI:1780454173
Name:AMBOUN, MARAM
Entity type:Individual
Prefix:
First Name:MARAM
Middle Name:
Last Name:AMBOUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1621
Mailing Address - Country:US
Mailing Address - Phone:510-549-6619
Mailing Address - Fax:
Practice Address - Street 1:225 CORONADO AVE APT 117
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-3325
Practice Address - Country:US
Practice Address - Phone:971-506-5861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician