Healthcare Provider Details

I. General information

NPI: 1104016336
Provider Name (Legal Business Name): HIBA ABDEL AZIZ I MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 11/23/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 N 40TH ST STE 227
PHOENIX AZ
85032-3354
US

IV. Provider business mailing address

16601 N 40TH ST STE 227
PHOENIX AZ
85032-3354
US

V. Phone/Fax

Practice location:
  • Phone: 602-633-3721
  • Fax: 602-595-1127
Mailing address:
  • Phone: 602-633-3721
  • Fax: 602-595-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD61445220
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number57.007748
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD-53288
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number57677
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: