Provider Demographics
NPI:1093504110
Name:OMAR, HIBAQ
Entity type:Individual
Prefix:
First Name:HIBAQ
Middle Name:
Last Name:OMAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26821 27TH PL S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-7994
Mailing Address - Country:US
Mailing Address - Phone:206-488-7375
Mailing Address - Fax:
Practice Address - Street 1:22415 SE 231ST ST
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5000
Practice Address - Country:US
Practice Address - Phone:425-906-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician