MEDICARE: AZITA BANANDARGAH

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	363LF0000X	Family Nurse Practitioner	NP95023261	CA

General Provider Information

NPI Number	:	1205549789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZITA BANANDARGAH

Provider Business Mailing Address
First Line	:	3652 W SHIELDS AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722
Country	:	US
Telephone Number	:	800-492-4227
Fax Number	:

Provider Business Practice Location Address
First Line	:	3652 W SHIELDS AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722
Country	:	US
Telephone Number	:	800-492-4227
Fax Number	:

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

Provider Enumeration Date	:	12/30/2022
Last Update Date	:	02/20/2026

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Directions to “ AZITA BANANDARGAH ” Practice Location

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