Provider Demographics
NPI:1962542761
Name:ALI, MARIAM THIAB (RNC CNM NURSEMIDWIFE)
Entity type:Individual
Prefix:MRS
First Name:MARIAM
Middle Name:THIAB
Last Name:ALI
Suffix:
Gender:
Credentials:RNC CNM NURSEMIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2096 CUSHMAN COURT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-5003
Mailing Address - Country:US
Mailing Address - Phone:805-584-6948
Mailing Address - Fax:
Practice Address - Street 1:1233 NORTH VERMONT AVENUE
Practice Address - Street 2:SUITE #2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029
Practice Address - Country:US
Practice Address - Phone:323-666-5116
Practice Address - Fax:323-666-1780
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW990367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANMW009901Medicaid