Provider Demographics
NPI:1992208789
Name:NURZAY, HAIDER M (NP)
Entity type:Individual
Prefix:MR
First Name:HAIDER
Middle Name:M
Last Name:NURZAY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N CALIFORNIA ST STE 11
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3758
Mailing Address - Country:US
Mailing Address - Phone:209-465-5891
Mailing Address - Fax:
Practice Address - Street 1:2800 N CALIFORNIA ST STE 11
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3758
Practice Address - Country:US
Practice Address - Phone:209-465-5891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA678008163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient