Healthcare Provider Details

I. General information

NPI: 1518895747
Provider Name (Legal Business Name): BACHIR EL HAJ OMAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E PIONEER AVE STE 203
HOMER AK
99603-7694
US

IV. Provider business mailing address

3800 SW 20TH AVE APT 502
GAINESVILLE FL
32607-4396
US

V. Phone/Fax

Practice location:
  • Phone: 907-435-1071
  • Fax:
Mailing address:
  • Phone: 561-917-3383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number254172
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: