Active NPI
Alexandra Timofeyevna Hazen-Nazaroff, D.M.D
- Dentist
- Fresno, CA
National Provider Identifier
1790019362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 58567
- Practice address
- 2615 E Clinton Ave
Vacchcs
Fresno, CA 93703-2223 - Phone
- (559) 225-6100
- NPI assigned
- Sep 29, 2009
- Last updated
- Dec 29, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 58567 | CA | Primary |
Addresses
Primary practice location
2615 E Clinton Ave
Vacchcs
Fresno, CA 93703-2223
Mailing address
5274 N Nantucket Ave
Fresno, CA 93704-2306
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58567 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451347200000",
"number": "1790019362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5274 N NANTUCKET AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937042306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2615 E CLINTON AVE",
"address_2": "VACCHCS",
"city": "FRESNO",
"state": "CA",
"postal_code": "937032223",
"telephone_number": "559-225-6100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAZEN-NAZAROFF",
"first_name": "ALEXANDRA",
"middle_name": "TIMOFEYEVNA",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-29",
"last_updated": "2015-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "58567",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.