MEDICARE: DR. BASSAM IBRAHIM ALZAGATITI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A56366	CA

General Provider Information

NPI Number	:	1831136738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASSAM IBRAHIM ALZAGATITI M.D.

Provider Business Mailing Address
First Line	:	1860 S CENTRAL ST
Second Line	:	# B
City	:	VISALIA
State	:	CA
Zip	:	93277-4418
Country	:	US
Telephone Number	:	559-738-1828
Fax Number	:	559-738-1953

Provider Business Practice Location Address
First Line	:	1860 S CENTRAL ST
Second Line	:	# B
City	:	VISALIA
State	:	CA
Zip	:	93277-4418
Country	:	US
Telephone Number	:	559-738-1828
Fax Number	:	559-738-1953

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/08/2007

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