Healthcare Provider Details

I. General information

NPI: 1508885781
Provider Name (Legal Business Name): BAZ ALLERGY, ASTHMA & SINUS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date: 10/29/2013
Reactivation Date: 04/13/2015

III. Provider practice location address

1420 SHAW AVE SUITE 105
CLOVIS CA
93611-4072
US

IV. Provider business mailing address

7471 N FRESNO ST
FRESNO CA
93720-2457
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-9990
  • Fax: 559-797-0004
Mailing address:
  • Phone: 559-436-4500
  • Fax: 559-261-1526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MALIK NASIR BAZ
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 559-436-4500