Healthcare Provider Details

I. General information

NPI: 1710183165
Provider Name (Legal Business Name): OUSSAMA I DAGHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E HAWKEYE AVE
TURLOCK CA
95380-7506
US

IV. Provider business mailing address

PO BOX 4978
MODESTO CA
95352-4978
US

V. Phone/Fax

Practice location:
  • Phone: 209-668-8030
  • Fax:
Mailing address:
  • Phone: 205-575-4575
  • Fax: 209-545-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA100106
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA100106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: