Healthcare Provider Details

I. General information

NPI: 1912158551
Provider Name (Legal Business Name): VICTOR AIRE-OAIHIMIRE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 W ROOSEVELT ST
PHOENIX AZ
85009-3404
US

IV. Provider business mailing address

3306 W ROOSEVELT ST
PHOENIX AZ
85009-3404
US

V. Phone/Fax

Practice location:
  • Phone: 602-278-4930
  • Fax: 602-269-7772
Mailing address:
  • Phone: 602-889-9401
  • Fax: 602-889-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3735
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: