Provider Demographics
NPI:1508595984
Name:ABDELAZIZ, AYA
Entity type:Individual
Prefix:
First Name:AYA
Middle Name:
Last Name:ABDELAZIZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11499 BARTLETT AVE
Mailing Address - Street 2:
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301-1902
Mailing Address - Country:US
Mailing Address - Phone:760-444-4258
Mailing Address - Fax:760-530-9977
Practice Address - Street 1:11499 BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-1902
Practice Address - Country:US
Practice Address - Phone:760-444-4258
Practice Address - Fax:760-530-9977
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS111255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist