Provider Demographics
NPI:1982279238
Name:RAJABALI, SAAD ROSHANALI
Entity Type:Individual
Prefix:
First Name:SAAD
Middle Name:ROSHANALI
Last Name:RAJABALI
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 1:1610 CHATEAU LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6287
Mailing Address - Country:US
Mailing Address - Phone:817-983-9674
Mailing Address - Fax:
Practice Address - Street 1:500 N INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-7443
Practice Address - Country:US
Practice Address - Phone:817-983-9674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty