1881157659 NPI number — MR. ABDEL AZIZ AL BAWAB M.D.

Table of content: MR. ABDEL AZIZ AL BAWAB M.D. (NPI 1881157659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881157659 NPI number — MR. ABDEL AZIZ AL BAWAB M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AL BAWAB
Provider First Name:
ABDEL AZIZ
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881157659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/27/2019
NPI Reactivation Date:
01/02/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6401 SANTA MONICA AVE NE APT 1042
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87109-4160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 UNIVERSITY OF NEW MEXICO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87131-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-5428
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)