Provider Demographics
NPI:1114927308
Name:BISHAY, NAZIUH NAIM (MD)
Entity Type:Individual
Prefix:DR
First Name:NAZIUH
Middle Name:NAIM
Last Name:BISHAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11221 DATURA LN
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-3641
Mailing Address - Country:US
Mailing Address - Phone:760-987-3468
Mailing Address - Fax:760-951-1609
Practice Address - Street 1:14011 PARK AVE
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2413
Practice Address - Country:US
Practice Address - Phone:888-750-0036
Practice Address - Fax:909-427-5033
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA85839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI17037Medicare UPIN
00A858390Medicare ID - Type Unspecified