Provider Demographics
NPI:1790719292
Name:JANJUA, NAZLI A (MD)
Entity Type:Individual
Prefix:DR
First Name:NAZLI
Middle Name:A
Last Name:JANJUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9016 SYCAMORE AVE
Mailing Address - Street 2:#210
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-1541
Mailing Address - Country:US
Mailing Address - Phone:917-574-4863
Mailing Address - Fax:
Practice Address - Street 1:1798 N GAREY AVE
Practice Address - Street 2:2ND FLOOR CATH LAB/NEUROINTERVENTIONAL
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2918
Practice Address - Country:US
Practice Address - Phone:909-962-8441
Practice Address - Fax:909-865-9945
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2245092084N0400X
CAA938062085R0204X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH76624Medicare UPIN