Provider Demographics
NPI:1437988722
Name:KOHANBANI, MARYAM (RNFA,CNOR)
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:KOHANBANI
Suffix:
Gender:F
Credentials:RNFA,CNOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W AZEELE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2297
Mailing Address - Country:US
Mailing Address - Phone:901-283-4227
Mailing Address - Fax:
Practice Address - Street 1:19208 JAMBOREE RD, UCI IRVINE
Practice Address - Street 2:NORTH CAMPUS CENTER FOR ADVANCED CARE
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612
Practice Address - Country:US
Practice Address - Phone:657-579-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95069260163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant