Individual
TAREQ NABULSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
11741 TELEGRAPH RD, SANTA FE SPRINGS, CA 90670-3681
(562) 801-0318
(562) 949-3642
Mailing address
849 KELLOGG AVE, JANESVILLE, WI 53546-2808
(608) 755-7960
(608) 755-7873
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT40247
CA
390200000X
Student in an Organized Health Care Education/Training Program
4087
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT40247
LICENSED PSYCHIATRIC TECHNICIAN
CA
Enumeration date
07/24/2012
Last updated
11/14/2017
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