Individual
SHADI RASHTAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
975 SERENO DR, VALLEJO, CA 94589-2441
(707) 651-1000
Mailing address
68 CAVALIER BLVD, FLORENCE, KY 41042-1645
(513) 475-7630
(859) 781-8374
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
35123652
OH
207N00000X
Dermatology Physician
47222
KY
207N00000X
Dermatology Physician
54232
MN
207N00000X
Dermatology Physician
Primary
A149698
CA
207N00000X
Dermatology Physician
V149698
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/28/2009
Last updated
02/02/2022
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