Provider Demographics
NPI:1912522574
Name:TARANISSI, OMAR AHMED (MD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:AHMED
Last Name:TARANISSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 DUBOCE AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-3389
Mailing Address - Country:US
Mailing Address - Phone:415-600-5959
Mailing Address - Fax:415-369-1392
Practice Address - Street 1:601 DUBOCE AVE STE 250
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3389
Practice Address - Country:US
Practice Address - Phone:415-600-5959
Practice Address - Fax:415-369-1392
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20200154962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry