Basic Information
Provider Information
NPI: 1275709883
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KLAR
FirstName: NITASHA
MiddleName: G.
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1867 E FIR AVE
Address2: SUITE 104
City: FRESNO
State: CA
PostalCode: 937203808
CountryCode: US
TelephoneNumber: 5593255809
FaxNumber: 5593255838
Practice Location
Address1: 1867 E FIR AVE
Address2: SUITE 104
City: FRESNO
State: CA
PostalCode: 937203808
CountryCode: US
TelephoneNumber: 5593255809
FaxNumber: 5593255838
Other Information
ProviderEnumerationDate: 05/03/2008
LastUpdateDate: 02/22/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085N0700XA146379CAY Allopathic & Osteopathic PhysiciansRadiologyNeuroradiology
2085R0202XA146379CAN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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