Provider Demographics
NPI:1588557532
Name:JANAN, MARIAM (ACS LION)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:JANAN
Suffix:
Gender:F
Credentials:ACS LION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6614 NORMAN LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3949
Mailing Address - Country:US
Mailing Address - Phone:619-606-0031
Mailing Address - Fax:
Practice Address - Street 1:2525 CAMINO DEL RIO S STE 125
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3742
Practice Address - Country:US
Practice Address - Phone:619-606-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist