Provider Demographics
NPI:1568879195
Name:RAHMAN, MARK
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:RAHMAN
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 1:7200 BANCROFT AVE STE 269
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2482
Mailing Address - Country:US
Mailing Address - Phone:510-746-1700
Mailing Address - Fax:510-746-1701
Practice Address - Street 1:1453 1ST ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4203
Practice Address - Country:US
Practice Address - Phone:925-583-3772
Practice Address - Fax:925-583-3771
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker