Basic Information
| Provider Information | |||||||||
| NPI: | 1881074748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAZ ALLERGY, ASTHMA & SINUS CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7471 N FRESNO ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937202457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594364500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1853 LANDER AVE | ||||||||
| Address2: | |||||||||
| City: | TURLOCK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953806240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594364500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2015 | ||||||||
| LastUpdateDate: | 06/10/2017 | ||||||||
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| AuthorizedOfficialLastName: | BAZ | ||||||||
| AuthorizedOfficialFirstName: | MALIK | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO/VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5594364500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207KA0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy |
ID Information
| ID | Type | State | Issuer | Description | GR0043790 | 05 | CA | MEDICAID | ZZZ21572Z | 01 | CA | GRP MCARE PTAN FOR BAZ ALLERGY, ASTHMA & SINUS CENTER | OTHER |