Provider Demographics
NPI:1932110699
Name:RAHMAN, BASHIRU ENIOLA
Entity Type:Individual
Prefix:
First Name:BASHIRU
Middle Name:ENIOLA
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 1:17306 SATICOY ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2435
Mailing Address - Country:US
Mailing Address - Phone:818-785-5543
Mailing Address - Fax:818-785-5532
Practice Address - Street 1:17306 SATICOY ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-2435
Practice Address - Country:US
Practice Address - Phone:818-785-5543
Practice Address - Fax:818-785-5532
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4414340001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies