MEDICARE: NIGAR YUSIFOVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	65117	CA

General Provider Information

NPI Number	:	1184034811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIGAR YUSIFOVA

Provider Business Mailing Address
First Line	:	4711 W ASHLAN AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-4307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4711 W ASHLAN AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-4307
Country	:	US
Telephone Number	:	310-990-2576
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2014
Last Update Date	:	10/12/2022

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Directions to “ NIGAR YUSIFOVA ” Practice Location

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