Healthcare Provider Details

I. General information

NPI: 1063678647
Provider Name (Legal Business Name): RAHIMAH A RAHIM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2008
Last Update Date: 08/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 NW 19TH ST
MIAMI FL
33136-1200
US

IV. Provider business mailing address

405 NW 19TH ST
MIAMI FL
33136-1200
US

V. Phone/Fax

Practice location:
  • Phone: 305-571-9404
  • Fax: 305-571-9404
Mailing address:
  • Phone: 305-571-9404
  • Fax: 305-571-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN9247312
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: