Provider Demographics
NPI:1376235564
Name:ZHELBAKOV, RUSLAN A
Entity Type:Individual
Prefix:
First Name:RUSLAN
Middle Name:A
Last Name:ZHELBAKOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4744 FITZHUGH RD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-2724
Mailing Address - Country:US
Mailing Address - Phone:307-949-0866
Mailing Address - Fax:
Practice Address - Street 1:4744 FITZHUGH RD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-2724
Practice Address - Country:US
Practice Address - Phone:307-949-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical