Provider Demographics
NPI:1427853506
Name:MICHMALI, OMAR (VOCATIONAL NURSE)
Entity type:Individual
Prefix:MR
First Name:OMAR
Middle Name:
Last Name:MICHMALI
Suffix:
Gender:M
Credentials:VOCATIONAL NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 WOODVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-3580
Mailing Address - Country:US
Mailing Address - Phone:209-864-1476
Mailing Address - Fax:
Practice Address - Street 1:1840 WOODVIEW CT
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-3580
Practice Address - Country:US
Practice Address - Phone:209-864-1476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA727231164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse