Provider Demographics
NPI:1093486482
Name:NAWAL, ROSHNIBAHEN
Entity Type:Individual
Prefix:
First Name:ROSHNIBAHEN
Middle Name:
Last Name:NAWAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34440 GOVE TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2650
Mailing Address - Country:US
Mailing Address - Phone:510-509-4071
Mailing Address - Fax:
Practice Address - Street 1:34440 GOVE TER
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-2650
Practice Address - Country:US
Practice Address - Phone:510-509-4071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51447225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant