Provider Demographics
NPI:1386308393
Name:EZUBEIK, OMAR FARAG
Entity type:Individual
Prefix:MR
First Name:OMAR
Middle Name:FARAG
Last Name:EZUBEIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 36TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1308
Mailing Address - Country:US
Mailing Address - Phone:209-298-2050
Mailing Address - Fax:
Practice Address - Street 1:2008 36TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1308
Practice Address - Country:US
Practice Address - Phone:209-298-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program