Healthcare Provider Details

I. General information

NPI: 1306406277
Provider Name (Legal Business Name): ABDUL KHALIQ ALCOZIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 FRESNO ST
FRESNO CA
93721-1324
US

IV. Provider business mailing address

45 E RIVER PARK PL W FL 5
FRESNO CA
93720-1562
US

V. Phone/Fax

Practice location:
  • Phone: 559-603-7378
  • Fax:
Mailing address:
  • Phone: 559-603-7378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA191705
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA191705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: