Provider Demographics
NPI:1770192015
Name:ZAKU, HIBA WALEED
Entity Type:Individual
Prefix:DR
First Name:HIBA
Middle Name:WALEED
Last Name:ZAKU
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 1:1594 NICHOLAS PL
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3378
Mailing Address - Country:US
Mailing Address - Phone:760-650-5658
Mailing Address - Fax:
Practice Address - Street 1:2990 JAMACHA RD STE 140
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-4387
Practice Address - Country:US
Practice Address - Phone:760-650-5658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1050551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice