Healthcare Provider Details

I. General information

NPI: 1831999192
Provider Name (Legal Business Name): FATIMA ZAHRAA BAHAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E COLUMBIA ST
OTHELLO WA
99344-1846
US

IV. Provider business mailing address

1170 NE 205TH TER
MIAMI FL
33179-2646
US

V. Phone/Fax

Practice location:
  • Phone: 509-488-5250
  • Fax: 509-488-9939
Mailing address:
  • Phone: 305-409-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA70020429
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: