Healthcare Provider Details

I. General information

NPI: 1841019379
Provider Name (Legal Business Name): HIBA G ANGALO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 KENNER ST
LUDLOW KY
41016-1476
US

IV. Provider business mailing address

2250 THUNDERSTICK DR STE 1104
LEXINGTON KY
40505-9009
US

V. Phone/Fax

Practice location:
  • Phone: 515-201-0001
  • Fax:
Mailing address:
  • Phone: 859-254-1035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: