Healthcare Provider Details

I. General information

NPI: 1497864649
Provider Name (Legal Business Name): NAZZI MOJIBI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NAZZI MOJIBI WALDROP MD

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 N RECREATION AVE STE 102
FRESNO CA
93720-8001
US

IV. Provider business mailing address

7050 N RECREATION AVE STE 102
FRESNO CA
93720-8001
US

V. Phone/Fax

Practice location:
  • Phone: 559-322-2918
  • Fax: 559-322-2936
Mailing address:
  • Phone: 559-322-2918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA81331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: