Healthcare Provider Details

I. General information

NPI: 1982284519
Provider Name (Legal Business Name): CARMEL RUSU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17635 ALMOND RD
CASTRO VALLEY CA
94546-1205
US

IV. Provider business mailing address

17635 ALMOND RD
CASTRO VALLEY CA
94546-1205
US

V. Phone/Fax

Practice location:
  • Phone: 510-886-0341
  • Fax: 410-200-9191
Mailing address:
  • Phone: 510-886-0341
  • Fax: 510-200-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number6030659740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: