Basic Information
Provider Information
NPI: 1619354248
EntityType: 2
ReplacementNPI:  
OrganizationName: BAZ ALLERGY, ASTHMA & SINUS CENTER, INC.
LastName:  
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MiddleName:  
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Credential:  
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Mailing Information
Address1: 7471 N FRESNO ST
Address2:  
City: FRESNO
State: CA
PostalCode: 937202457
CountryCode: US
TelephoneNumber: 5594364500
FaxNumber:  
Practice Location
Address1: 2021 HERNDON AVE
Address2: SUITE 101
City: CLOVIS
State: CA
PostalCode: 936116101
CountryCode: US
TelephoneNumber: 5594364500
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/04/2015
LastUpdateDate: 06/10/2017
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: BAZ
AuthorizedOfficialFirstName: MALIK
AuthorizedOfficialMiddleName: N
AuthorizedOfficialTitleorPosition: CEO/PRESIDENT
AuthorizedOfficialTelephone: 5594364500
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207KA0200X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy

ID Information
IDTypeStateIssuerDescription
ZZZ21572Z01CAGRP MCARE PTAN FOR BAZ ALLERGHY ASTHMA SINUS CENTEROTHER
GR004379005CA MEDICAID


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