Provider Demographics
NPI:1386310829
Name:BELFAQEEH, OMAR (MB BCH BAO)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:BELFAQEEH
Suffix:
Gender:M
Credentials:MB BCH BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GILMAN DR. LA JOLLA,
Mailing Address - Street 2:MC 0956
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:619-543-2347
Mailing Address - Fax:
Practice Address - Street 1:9500 GILMAN DRIVE LA JOLLA CA 92037
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:917-439-4503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program