Provider Demographics
NPI:1689763781
Name:ARJOMAND, MARYAM (MD)
Entity type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:ARJOMAND
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 1:136 N SAN MATEO DR
Mailing Address - Street 2:#101
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2777
Mailing Address - Country:US
Mailing Address - Phone:650-344-1114
Mailing Address - Fax:650-344-2274
Practice Address - Street 1:136 NORTH SAN MATEO DR
Practice Address - Street 2:#1010
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401
Practice Address - Country:US
Practice Address - Phone:650-344-1114
Practice Address - Fax:650-344-2274
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061705174400000X
CA00A617050207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20-5280112OtherTAX ID NUMBER
CA00A617050Medicare ID - Type UnspecifiedPROVIDER NUMBER
CAG88953Medicare UPIN