Provider Demographics
NPI:1497864649
Name:MOJIBI, NAZZI (MD)
Entity Type:Individual
Prefix:
First Name:NAZZI
Middle Name:
Last Name:MOJIBI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAZZI
Other - Middle Name:
Other - Last Name:MOJIBI WALDROP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7050 N RECREATION AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8001
Mailing Address - Country:US
Mailing Address - Phone:559-322-2918
Mailing Address - Fax:
Practice Address - Street 1:7050 N RECREATION AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8001
Practice Address - Country:US
Practice Address - Phone:559-322-2918
Practice Address - Fax:559-322-2936
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81331208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A813310Medicaid
CA00A813310Medicare ID - Type Unspecified
CA00A813310Medicaid