Healthcare Provider Details

I. General information

NPI: 1841547494
Provider Name (Legal Business Name): SYEDA NAZISH AZIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31180 ROAD 72
VISALIA CA
93291-9672
US

IV. Provider business mailing address

305 E CENTER AVE
VISALIA CA
93291-6331
US

V. Phone/Fax

Practice location:
  • Phone: 559-737-4700
  • Fax: 559-734-1247
Mailing address:
  • Phone: 361-960-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number137445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: