Individual
MR. SALIM OTIENO ODIERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9138 E DENNIS ST, MESA, AZ 85207-6008
(480) 380-4413
(480) 530-5408
Mailing address
9138 E DENNIS ST, MESA, AZ 85207-6008
(480) 380-4413
(480) 530-5408
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH5615
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
465372
—
AZ
Enumeration date
09/21/2020
Last updated
09/21/2020
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