MEDICARE: MR. HAIDER M NURZAY NP

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	163WX0003X	Inpatient Obstetric Registered Nurse	678008	CA

General Provider Information

NPI Number	:	1992208789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HAIDER M NURZAY NP

Provider Business Mailing Address
First Line	:	2800 N CALIFORNIA ST STE 11
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-3758
Country	:	US
Telephone Number	:	209-465-5891
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 N CALIFORNIA ST STE 11
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-3758
Country	:	US
Telephone Number	:	209-465-5891
Fax Number	:

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

Provider Enumeration Date	:	03/17/2018
Last Update Date	:	03/17/2018

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