Provider Demographics
NPI:1619723889
Name:ABDULAZIZ, ABUBAKR
Entity Type:Individual
Prefix:
First Name:ABUBAKR
Middle Name:
Last Name:ABDULAZIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 HARDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1970
Mailing Address - Country:US
Mailing Address - Phone:225-407-6818
Mailing Address - Fax:
Practice Address - Street 1:1646 HARDWOOD CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1970
Practice Address - Country:US
Practice Address - Phone:225-407-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility