Healthcare Provider Details

I. General information

NPI: 1306228523
Provider Name (Legal Business Name): MAZHAR ULLAH BAJWA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11611 S FOOTHILLS BLVD STE G
YUMA AZ
85367-5845
US

IV. Provider business mailing address

11611 S FOOTHILLS BLVD STE G
YUMA AZ
85367-5845
US

V. Phone/Fax

Practice location:
  • Phone: 928-955-0037
  • Fax: 928-955-0038
Mailing address:
  • Phone: 928-955-0037
  • Fax: 928-955-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP7946
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7946
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: