Provider Demographics
NPI:1366438806
Name:RASUL, MARIA CECELIA A (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CECELIA A
Last Name:RASUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 JOHNSON AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4175
Mailing Address - Country:US
Mailing Address - Phone:805-786-4111
Mailing Address - Fax:805-543-6357
Practice Address - Street 1:1941 JOHNSON AVE STE 301
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4175
Practice Address - Country:US
Practice Address - Phone:805-786-4111
Practice Address - Fax:805-543-6357
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51160207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB243502OtherMEDICARE ID
AZ939689Medicaid