Healthcare Provider Details

I. General information

NPI: 1558792754
Provider Name (Legal Business Name): RAFI ABDUSSATAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9405 MARAH AVE
CLEVELAND OH
44104-5431
US

IV. Provider business mailing address

9405 MARAH AVE
CLEVELAND OH
44104-5431
US

V. Phone/Fax

Practice location:
  • Phone: 216-925-6544
  • Fax:
Mailing address:
  • Phone: 216-925-6544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: