Provider Demographics
NPI:1063081073
Name:CHAUDHRY, OMAR Y (LAC)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:Y
Last Name:CHAUDHRY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 STEPHEN RD APT A
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4667
Mailing Address - Country:US
Mailing Address - Phone:831-454-6569
Mailing Address - Fax:
Practice Address - Street 1:11 ALEXANDER ST STE D
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4626
Practice Address - Country:US
Practice Address - Phone:831-471-7814
Practice Address - Fax:831-708-0147
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist