Provider Demographics
NPI:1598541716
Name:DAHIR, ABDIMALIK
Entity Type:Individual
Prefix:
First Name:ABDIMALIK
Middle Name:
Last Name:DAHIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4612 W PIEDMONT RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2096
Mailing Address - Country:US
Mailing Address - Phone:949-302-1283
Mailing Address - Fax:
Practice Address - Street 1:4612 W PIEDMONT RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2096
Practice Address - Country:US
Practice Address - Phone:949-302-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities