Provider Demographics
NPI:1376025981
Name:RANGWALA, RABAB
Entity Type:Individual
Prefix:
First Name:RABAB
Middle Name:
Last Name:RANGWALA
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 1:1741 SILVERADO CIR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-5776
Mailing Address - Country:US
Mailing Address - Phone:415-316-8191
Mailing Address - Fax:
Practice Address - Street 1:678 2ND ST W # SREETW
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6901
Practice Address - Country:US
Practice Address - Phone:707-938-1096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12484235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist