Healthcare Provider Details

I. General information

NPI: 1790971711
Provider Name (Legal Business Name): RABAB RADWAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 SONOMA ST
REDDING CA
96001-3027
US

IV. Provider business mailing address

2175 ROSALINE AVE
REDDING CA
96001-2509
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-7800
  • Fax: 530-225-7888
Mailing address:
  • Phone: 530-225-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA108872
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA108872
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA108872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: