Provider Demographics
NPI:1629899208
Name:QASEM, RUBA (SA-C)
Entity type:Individual
Prefix:
First Name:RUBA
Middle Name:
Last Name:QASEM
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 FALCON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-2608
Mailing Address - Country:US
Mailing Address - Phone:872-210-7324
Mailing Address - Fax:
Practice Address - Street 1:9101 FALCON RIDGE DR
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-2608
Practice Address - Country:US
Practice Address - Phone:872-210-7324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000816246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant