Provider Demographics
NPI:1770898967
Name:OMMANI, SOPHIA J (MD)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:J
Last Name:OMMANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7121 S PADRE ISLAND DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4940
Mailing Address - Country:US
Mailing Address - Phone:361-985-7110
Mailing Address - Fax:
Practice Address - Street 1:7121 S PADRE ISLAND DR STE 200
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4940
Practice Address - Country:US
Practice Address - Phone:361-985-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6486207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810018275Medicaid
WVP00881819OtherRAILROAD MEDICARE
WVP00881819OtherRAILROAD MEDICARE