Healthcare Provider Details

I. General information

NPI: 1124284625
Provider Name (Legal Business Name): HAMIDULLAH HABIB FALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14749 W MOUNTAIN VIEW BLVD STE 138
SURPRISE AZ
85374-2704
US

IV. Provider business mailing address

14749 W MOUNTAIN VIEW BLVD STE 138
SURPRISE AZ
85374-2704
US

V. Phone/Fax

Practice location:
  • Phone: 623-738-0440
  • Fax: 480-374-8051
Mailing address:
  • Phone: 623-738-0440
  • Fax: 480-374-8051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43045
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number43045
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: