Healthcare Provider Details

I. General information

NPI: 1568304319
Provider Name (Legal Business Name): TAWHID ISLAM RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TAWHIDUL ISLAM RN

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 CROSSWIND CT
HERCULES CA
94547-1547
US

IV. Provider business mailing address

132 CROSSWIND CT
HERCULES CA
94547-1547
US

V. Phone/Fax

Practice location:
  • Phone: 917-623-5101
  • Fax:
Mailing address:
  • Phone: 917-623-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95280789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: