Provider Demographics
NPI:1598039208
Name:BAZZY, ABBAS ALI (ND)
Entity Type:Individual
Prefix:DR
First Name:ABBAS
Middle Name:ALI
Last Name:BAZZY
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 E HERNDON AVE
Mailing Address - Street 2:# 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3164
Mailing Address - Country:US
Mailing Address - Phone:559-389-0622
Mailing Address - Fax:
Practice Address - Street 1:1191 E HERNDON AVE
Practice Address - Street 2:# 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3164
Practice Address - Country:US
Practice Address - Phone:559-389-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11-1273175F00000X
CAND-518175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath