Provider Demographics
NPI:1023996824
Name:AL-OMAIRA, BANDAR KHALED
Entity type:Individual
Prefix:
First Name:BANDAR
Middle Name:KHALED
Last Name:AL-OMAIRA
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 1:695 CLAUDIUS WAY
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-8532
Mailing Address - Country:US
Mailing Address - Phone:559-304-0833
Mailing Address - Fax:
Practice Address - Street 1:1355 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-6500
Practice Address - Country:US
Practice Address - Phone:707-736-0690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool