Individual
DR. MARYAM ARDALAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
A102198
CA
207VG0400X
Gynecology Physician
A102198
CA
207VX0000X
Obstetrics Physician
Primary
A102198
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A1021980
—
CA
01
—
0A1021980
BLUE SHIELD
CA
Enumeration date
08/06/2007
Last updated
02/22/2023
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