Provider Demographics
NPI:1366829921
Name:NURGOZHA, AISULU (MD)
Entity Type:Individual
Prefix:MRS
First Name:AISULU
Middle Name:
Last Name:NURGOZHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 LINDEN AVE
Mailing Address - Street 2:GRADUATE MEDICAL EDUCATION
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3321
Mailing Address - Country:US
Mailing Address - Phone:562-491-9350
Mailing Address - Fax:562-491-9146
Practice Address - Street 1:201 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046
Practice Address - Country:US
Practice Address - Phone:703-237-4000
Practice Address - Fax:703-237-4000
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235730390200000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program