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General NPI Number Information
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NPI Number | 1366829921
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Entity Type | Individual
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Provider Name | AISULU NURGOZHA M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 201 N WASHINGTON ST
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City | FALLS CHURCH
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State | VA
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Zip | 22046
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Country | US
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Telephone | 703-237-4000
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Fax | 703-237-4000
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Provider Business Mailing Address
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Address Line | 1050 LINDEN AVE GRADUATE MEDICAL EDUCATION
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City | LONG BEACH
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State | CA
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Zip | 90813-3321
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Country | US
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Telephone | 562-491-9350
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Fax | 562-491-9146
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 235730
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 235730
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License Number State | CA
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