Provider Demographics
NPI:1477348811
Name:HUMAYOON KABIR THEEPURA, ANZAL
Entity type:Individual
Prefix:
First Name:ANZAL
Middle Name:
Last Name:HUMAYOON KABIR THEEPURA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ANZAL
Other - Middle Name:H
Other - Last Name:THEEPURA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:DESERT VALLEY HOSPITAL
Mailing Address - Street 2:16850 BEAR VALLEY RD
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395
Mailing Address - Country:US
Mailing Address - Phone:760-241-8000
Mailing Address - Fax:
Practice Address - Street 1:DESERT VALLEY HOSPITAL
Practice Address - Street 2:16850 BEAR VALLEY RD
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395
Practice Address - Country:US
Practice Address - Phone:760-241-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program