Healthcare Provider Details

I. General information

NPI: 1508408808
Provider Name (Legal Business Name): SHAZIA BASHIR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 SAN DIMAS ST STE A200
BAKERSFIELD CA
93301-1115
US

IV. Provider business mailing address

3400 DATA DR ATTN CREDENTIALING/PAYER ENROLLMENT
RANCHO CODOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 661-654-0200
  • Fax: 661-664-2855
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: