Healthcare Provider Details

I. General information

NPI: 1568644797
Provider Name (Legal Business Name): NAZZI MOJIBI WALDROP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 N RECREATION AVE #102
FRESNO CA
93720
US

IV. Provider business mailing address

7050 N RECREATION AVE #102
FRESNO CA
93720
US

V. Phone/Fax

Practice location:
  • Phone: 559-322-2900
  • Fax: 559-322-2901
Mailing address:
  • Phone: 559-322-2900
  • Fax: 559-322-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: NAZZI MOJIBI WALDROP
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 559-322-2900