Provider Demographics
NPI:1831910298
Name:AL SHIHAB, RUSUL
Entity type:Individual
Prefix:
First Name:RUSUL
Middle Name:
Last Name:AL SHIHAB
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 1:320 N 10TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-0345
Mailing Address - Country:US
Mailing Address - Phone:916-776-3949
Mailing Address - Fax:
Practice Address - Street 1:320 N 10TH ST STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-0345
Practice Address - Country:US
Practice Address - Phone:916-776-3949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver