Provider Demographics
NPI:1205208675
Name:BAZ ALLERGY, ASTHMA & SINUS CENTER
Entity Type:Organization
Organization Name:BAZ ALLERGY, ASTHMA & SINUS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALIK
Authorized Official - Middle Name:NASIR
Authorized Official - Last Name:BAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-436-4500
Mailing Address - Street 1:7471 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2457
Mailing Address - Country:US
Mailing Address - Phone:559-436-4500
Mailing Address - Fax:559-261-1526
Practice Address - Street 1:1860 MOWRY AVE STE 400
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1730
Practice Address - Country:US
Practice Address - Phone:510-894-0051
Practice Address - Fax:510-894-1578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2017-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35393207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0043790Medicaid
CAZZZ21572ZOtherGRP MCARE PTAN FOR BAZ ALLERGY, ASTHMA & SINUS CENTER