Provider Demographics
NPI:1609172550
Name:RASTAU, SORIN
Entity Type:Individual
Prefix:MS
First Name:SORIN
Middle Name:
Last Name:RASTAU
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 1:16118 N 168TH LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-1350
Mailing Address - Country:US
Mailing Address - Phone:623-328-9457
Mailing Address - Fax:623-328-9457
Practice Address - Street 1:16118 N 168TH LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-1350
Practice Address - Country:US
Practice Address - Phone:623-328-9457
Practice Address - Fax:623-328-9457
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL8307H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility