Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 22782 | AZ |
NPI | 1063404531 |
---|---|
Provider Name | Fadia K Habib-Khazen |
First Address | Phoenix, AZ 85015-1934 |
Second Address | Phoenix, AZ 85015-1934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 28/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007204 | (05) | AZ |
E83102 | (02) |