Provider Demographics
NPI:1114440401
Name:BABA, ABDUL NEGEDU
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:NEGEDU
Last Name:BABA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7467 N ORACLE RD STE 131
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6578
Mailing Address - Country:US
Mailing Address - Phone:520-395-0714
Mailing Address - Fax:520-844-7005
Practice Address - Street 1:7467 N ORACLE RD STE 131
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6578
Practice Address - Country:US
Practice Address - Phone:520-395-0714
Practice Address - Fax:520-844-7005
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2024-12-09
Deactivation Date:2019-12-09
Deactivation Code:
Reactivation Date:2020-01-24
Provider Licenses
StateLicense IDTaxonomies
AZAP10787363LP0808X
TXAP134356363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty