Provider Demographics
NPI:1528837952
Name:OMARIBA, VICTOR (CNA)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:OMARIBA
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:OMARIBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA
Mailing Address - Street 1:8909 S 235TH PL APT HH101
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-2945
Mailing Address - Country:US
Mailing Address - Phone:425-306-3910
Mailing Address - Fax:
Practice Address - Street 1:3725 PROVIDENCE POINT DR SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-7219
Practice Address - Country:US
Practice Address - Phone:425-391-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61420493376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide