MEDICARE: RABAB RANGWALA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	12484	CA

General Provider Information

NPI Number	:	1376025981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RABAB RANGWALA

Provider Business Mailing Address
First Line	:	1741 SILVERADO CIR
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94954-5776
Country	:	US
Telephone Number	:	415-316-8191
Fax Number	:

Provider Business Practice Location Address
First Line	:	678 2ND ST W # SREETW
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-6901
Country	:	US
Telephone Number	:	707-938-1096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	08/30/2018

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Directions to “ RABAB RANGWALA ” Practice Location

Language	Start Address	Practice Location

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