Provider Demographics
NPI:1669064457
Name:OMAR, FARIYO
Entity type:Individual
Prefix:
First Name:FARIYO
Middle Name:
Last Name:OMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7135 WESTVIEW PL APT B
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1427
Mailing Address - Country:US
Mailing Address - Phone:619-757-0201
Mailing Address - Fax:
Practice Address - Street 1:7135 WESTVIEW PL APT B
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1427
Practice Address - Country:US
Practice Address - Phone:619-757-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86-1868400Medicaid