Healthcare Provider Details

I. General information

NPI: 1750732442
Provider Name (Legal Business Name): REBEKA SULTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2194 LONGFELLOW AVENUE
WINDSOR ONTARIO
N9B3J6
CA

IV. Provider business mailing address

2194 LONGFELLOW AVENUE
WINDSOR ONTARIO
N9B3J6
CA

V. Phone/Fax

Practice location:
  • Phone: 309-256-6044
  • Fax:
Mailing address:
  • Phone: 309-256-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: