Provider Demographics
NPI:1700873593
Name:AZIZ, IHAB NAIM (MD)
Entity Type:Individual
Prefix:
First Name:IHAB
Middle Name:NAIM
Last Name:AZIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16917 ENADIA WAY
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3602
Mailing Address - Country:US
Mailing Address - Phone:818-401-1010
Mailing Address - Fax:818-401-1212
Practice Address - Street 1:16917 ENADIA WAY
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3602
Practice Address - Country:US
Practice Address - Phone:818-401-1010
Practice Address - Fax:818-401-1212
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66104208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH94999Medicare UPIN
CAWA66104AMedicare ID - Type Unspecified