MEDICARE: ZIYODAKHON GAZIEVA

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	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780243485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZIYODAKHON GAZIEVA

Provider Business Mailing Address
First Line	:	11407 VISTA HAVEN DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-3648
Country	:	US
Telephone Number	:	980-337-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	11407 VISTA HAVEN DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-3648
Country	:	US
Telephone Number	:	980-337-0333
Fax Number	:

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

Provider Enumeration Date	:	06/07/2019
Last Update Date	:	06/07/2019

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