Provider Demographics
NPI:1912500828
Name:TALHAMI, AZZAM
Entity Type:Individual
Prefix:
First Name:AZZAM
Middle Name:
Last Name:TALHAMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 BUTTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1008
Mailing Address - Country:US
Mailing Address - Phone:909-990-8032
Mailing Address - Fax:
Practice Address - Street 1:436 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-5237
Practice Address - Country:US
Practice Address - Phone:619-493-1184
Practice Address - Fax:888-498-3776
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 106H00000X
CA130346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional