Healthcare Provider Details

I. General information

NPI: 1538741178
Provider Name (Legal Business Name): ASHIQUE RABBANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8465 W SAHARA AVE. SUITE 111 #316
LAS VEGAS NV
89117
US

IV. Provider business mailing address

8465 W SAHARA AVE. SUITE 111 #316
LAS VEGAS NV
89117
US

V. Phone/Fax

Practice location:
  • Phone: 725-735-4145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2258
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: