Basic Information
| Provider Information | |||||||||
| NPI: | 1699107706 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RASOUL SCHOLZ MD A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55243 | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952058743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093399022 | ||||||||
| FaxNumber: | 2093399033 | ||||||||
| Practice Location | |||||||||
| Address1: | 1006 NUT TREE RD | ||||||||
| Address2: | |||||||||
| City: | VACAVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956874100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093399022 | ||||||||
| FaxNumber: | 2093399033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2013 | ||||||||
| LastUpdateDate: | 06/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | SCHOLZ | ||||||||
| AuthorizedOfficialFirstName: | RASOUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | ANESTHESIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 2093399022 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | A77903 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
ID Information
| ID | Type | State | Issuer | Description | A77903 | 01 | CA | MEDICAL LICENSE | OTHER |