Provider Demographics
NPI:1295210920
Name:ALABDULLAH, HIBA
Entity Type:Individual
Prefix:
First Name:HIBA
Middle Name:
Last Name:ALABDULLAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6482 AMBROSIA DR APT 5106
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-3143
Mailing Address - Country:US
Mailing Address - Phone:310-218-8140
Mailing Address - Fax:
Practice Address - Street 1:6482 AMBROSIA DR APT 5106
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-3143
Practice Address - Country:US
Practice Address - Phone:310-218-8140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1024981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty