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General NPI Number Information
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NPI Number | 1326495235
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Entity Type | Individual
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Provider Name | KOMOLA AZIMOVA SHABAN MD
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Gender | Female
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Dates
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Enumeration Date | 05/20/2016
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 2071 HERNDON AVE
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City | CLOVIS
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State | CA
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Zip | 93611-6101
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Country | US
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Telephone | 512-650-6550
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Fax |
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Provider Business Mailing Address
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Address Line | 5319 DUPUY CIR
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City | TEMPLE CITY
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State | CA
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Zip | 91780-3165
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Country | US
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Telephone | 512-650-6550
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | A174548
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License Number State | CA
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