Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A35393 | CA |
N | 208000000X | Pediatrician | A35393 | CA |
NPI | 1114923307 |
---|---|
Provider Name | Malik Nasir Baz |
First Address | Fresno, CA 93720-2457 |
Second Address | Fresno, CA 93720-2457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 25/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114923307 | (05) | CA |
GR0043790 | (05) | CA |
ZZZ21572Z | PTAN FOR ALL OFFICE LOCATIONS: BAZ ALLERGY, ASTHMA & SINUS CENTER (01) | CA |