Provider Demographics
NPI:1598881229
Name:QAZI, NAWAZISH SHAHDIN (MD)
Entity Type:Individual
Prefix:
First Name:NAWAZISH
Middle Name:SHAHDIN
Last Name:QAZI
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 1:264 N HIGHLAND SPRINGS AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-3082
Mailing Address - Country:US
Mailing Address - Phone:951-845-8856
Mailing Address - Fax:951-845-7256
Practice Address - Street 1:264 N HIGHLAND SPRINGS AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3082
Practice Address - Country:US
Practice Address - Phone:951-845-8856
Practice Address - Fax:951-845-7256
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39227OtherTRICARE
CAA392270Medicaid
CAA392270Medicaid
CAA39227OtherTRICARE