Healthcare Provider Details

I. General information

NPI: 1841069135
Provider Name (Legal Business Name): ANISA ALI DAHIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 HARRISON AVE RM 510A
BOSTON MA
02111-1817
US

IV. Provider business mailing address

7526 MONTEREY ST
GILROY CA
95020-5826
US

V. Phone/Fax

Practice location:
  • Phone: 801-895-6825
  • Fax:
Mailing address:
  • Phone: 408-848-9400
  • Fax: 408-848-9464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: