Individual
NAGMO M FATAKHOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9520 63RD RD STE J, REGO PARK, NY 11374-1145
(858) 279-1223
(619) 516-4757
Mailing address
4550 KEARNY VILLA RD, SUITE116, SAN DIEGO, CA 92123-1578
(858) 279-1223
(619) 295-3365
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
219009
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00622960
—
CA
05
—
04321399
—
NY
Enumeration date
07/20/2006
Last updated
10/04/2018
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