Healthcare Provider Details

I. General information

NPI: 1710900634
Provider Name (Legal Business Name): BAZ ALLERGY, ASTHMA & SINUS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 HERNDON AVE STE 102
CLOVIS CA
93611-6101
US

IV. Provider business mailing address

7471 N FRESNO ST
FRESNO CA
93720-2457
US

V. Phone/Fax

Practice location:
  • Phone: 559-472-3116
  • Fax:
Mailing address:
  • Phone: 559-436-4500
  • Fax:

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: CFO/VICE PRESIDENT
Credential: M.D.
Phone: 559-436-4500