Provider Demographics
NPI:1932612306
Name:NIAZI, HAYATULLAH (PA)
Entity Type:Individual
Prefix:
First Name:HAYATULLAH
Middle Name:
Last Name:NIAZI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8191 TIMBERLAKE WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5419
Mailing Address - Country:US
Mailing Address - Phone:916-688-8888
Mailing Address - Fax:
Practice Address - Street 1:8191 TIMBERLAKE WAY STE 400
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5419
Practice Address - Country:US
Practice Address - Phone:916-688-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA843383163W00000X
CA55054363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No163W00000XNursing Service ProvidersRegistered Nurse