Provider Demographics
NPI:1679339378
Name:WAHAB, FATIMA
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:WAHAB
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 1:13902 GERSHON PL
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2646
Mailing Address - Country:US
Mailing Address - Phone:714-514-4006
Mailing Address - Fax:
Practice Address - Street 1:9836 WHITE OAK AVE STE 101
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4843
Practice Address - Country:US
Practice Address - Phone:714-514-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty