Provider Demographics
NPI:1982284519
Name:RUSU, CARMEL
Entity Type:Individual
Prefix:
First Name:CARMEL
Middle Name:
Last Name:RUSU
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 1:17635 ALMOND RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-1205
Mailing Address - Country:US
Mailing Address - Phone:510-886-0341
Mailing Address - Fax:510-200-9191
Practice Address - Street 1:17635 ALMOND RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-1205
Practice Address - Country:US
Practice Address - Phone:510-886-0341
Practice Address - Fax:410-200-9191
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60306597403747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider