Healthcare Provider Details

I. General information

NPI: 1184513772
Provider Name (Legal Business Name): BURAQ HOLDING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 SUGAR GROVE AVE
INDIANAPOLIS IN
46202-1132
US

IV. Provider business mailing address

1849 SUGAR GROVE AVE
INDIANAPOLIS IN
46202-1132
US

V. Phone/Fax

Practice location:
  • Phone: 619-394-2059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: RABAB BOULASBAA
Title or Position: MANAGER
Credential:
Phone: 619-394-2059