Provider Demographics
NPI:1306228523
Name:BAJWA, MAZHAR
Entity Type:Individual
Prefix:
First Name:MAZHAR
Middle Name:
Last Name:BAJWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2329
Mailing Address - Country:US
Mailing Address - Phone:928-919-2305
Mailing Address - Fax:928-276-4012
Practice Address - Street 1:11468 N FRONTAGE RD
Practice Address - Street 2:STE A
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-8970
Practice Address - Country:US
Practice Address - Phone:928-342-6500
Practice Address - Fax:928-342-6863
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN71876NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily