Provider Demographics
NPI:1104291616
Name:OMER, FAISAL
Entity type:Individual
Prefix:
First Name:FAISAL
Middle Name:
Last Name:OMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NUREDDIS
Other - Middle Name:
Other - Last Name:HABEB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17933 KENAI FJORDS DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5255
Mailing Address - Country:US
Mailing Address - Phone:512-905-0597
Mailing Address - Fax:
Practice Address - Street 1:17933 KENAI FJORDS DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5255
Practice Address - Country:US
Practice Address - Phone:512-905-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18302073343900000X
TX23407463343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)