Healthcare Provider Details

I. General information

NPI: 1992464887
Provider Name (Legal Business Name): OLIVER DAAHIR SOIDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST RECONNAISSANCE BT
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

6430 N CAMINO PADRE ISIDORO
TUCSON AZ
85718-2032
US

V. Phone/Fax

Practice location:
  • Phone: 760-390-9244
  • Fax:
Mailing address:
  • Phone: 520-861-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: