Provider Demographics
NPI:1558549436
Name:TAHIRU, ADAMU ALHAJI (PA)
Entity Type:Individual
Prefix:MR
First Name:ADAMU
Middle Name:ALHAJI
Last Name:TAHIRU
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 YAQUI PASS ROAD
Mailing Address - Street 2:
Mailing Address - City:BORREGO SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92004
Mailing Address - Country:US
Mailing Address - Phone:760-767-5051
Mailing Address - Fax:760-767-4552
Practice Address - Street 1:4343 YAQUI PASS ROAD
Practice Address - Street 2:
Practice Address - City:BORREGO SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92004
Practice Address - Country:US
Practice Address - Phone:760-767-5051
Practice Address - Fax:760-767-4552
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14686363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA14686OtherCALIFORNIA LICENSE NUMBER