Healthcare Provider Details

I. General information

NPI: 1972983815
Provider Name (Legal Business Name): BAZ ALLERGY, ASTHMA & SINUS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 06/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BADGER FLAT RD A
LOS BANOS CA
93635-8600
US

IV. Provider business mailing address

7471 N FRESNO ST
FRESNO CA
93720-2457
US

V. Phone/Fax

Practice location:
  • Phone: 209-710-8684
  • Fax: 209-710-8763
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: MALIK BAZ
Title or Position: CFO/VICE PRESIDENT
Credential: M.D.
Phone: 559-436-4500