Healthcare Provider Details

I. General information

NPI: 1891307914
Provider Name (Legal Business Name): SHAABAN GHAUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39155 LIBERTY ST STE E500
FREMONT CA
94538-1516
US

IV. Provider business mailing address

4555 THORNTON AVE APT 57
FREMONT CA
94536-5647
US

V. Phone/Fax

Practice location:
  • Phone: 510-574-2100
  • Fax:
Mailing address:
  • Phone: 925-350-9035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: