Provider Demographics
NPI:1912395245
Name:KABIA, AZICK
Entity Type:Individual
Prefix:
First Name:AZICK
Middle Name:
Last Name:KABIA
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 1:9883 GOOD LUCK RD # R
Mailing Address - Street 2:APT 12
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3215
Mailing Address - Country:US
Mailing Address - Phone:240-515-2140
Mailing Address - Fax:
Practice Address - Street 1:9883 GOOD LUCK RD # R
Practice Address - Street 2:APT 12
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3215
Practice Address - Country:US
Practice Address - Phone:240-515-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1004016164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse