Provider Demographics
NPI:1942613674
Name:RASULOV, SABINA
Entity Type:Individual
Prefix:
First Name:SABINA
Middle Name:
Last Name:RASULOV
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 1:542 N VISTA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5743
Mailing Address - Country:US
Mailing Address - Phone:323-658-8722
Mailing Address - Fax:323-782-0153
Practice Address - Street 1:542 N VISTA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-5743
Practice Address - Country:US
Practice Address - Phone:323-658-8722
Practice Address - Fax:323-782-0153
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197608059311ZA0620X
CA197608060311ZA0620X
CA197608058311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home