Healthcare Provider Details

I. General information

NPI: 1699428730
Provider Name (Legal Business Name): ITAB ALI NAGI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2022
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E ALMOND AVE
MADERA CA
93637-5698
US

IV. Provider business mailing address

1992 N FORESTIERE AVE
FRESNO CA
93722-8730
US

V. Phone/Fax

Practice location:
  • Phone: 559-664-4000
  • Fax: 559-675-5224
Mailing address:
  • Phone: 559-328-7605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: