Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | A56116 | CA |
Y | 208D00000X | General Practice Physician | A56116 | CA |
NPI | 1669747747 |
---|---|
Provider Name | Dr. Shahida Naz |
First Address | San Bernardino, CA 92423-1325 |
Second Address | Calipatria, CA 92233-9633 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2012 |
Last Update Date | 21/03/2012 |