Healthcare Provider Details

I. General information

NPI: 1285574855
Provider Name (Legal Business Name): TINA AZOH HUNDITO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 6TH AVE
DES MOINES IA
50314-2613
US

IV. Provider business mailing address

1111 6TH AVE
DES MOINES IA
50314-2613
US

V. Phone/Fax

Practice location:
  • Phone: 515-612-9595
  • Fax: 515-346-6721
Mailing address:
  • Phone: 515-612-9595
  • Fax: 515-346-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-10276481833
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-14001
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: