Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G52073 | CA |
NPI | 1063594372 |
---|---|
Provider Name | Rashad Ansari |
First Address | Vista, CA 92083-6030 |
Second Address | Vista, CA 92083-6030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 07/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110009177 | MEDICARE RAILROAD (01) | CA |
A06635 | (02) | CA |