Provider Demographics
NPI:1992948764
Name:OMLOR, AARON MICHAEL (PA)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:MICHAEL
Last Name:OMLOR
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1445 PASSAGE ST
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-0587
Mailing Address - Country:US
Mailing Address - Phone:047-081-2749
Mailing Address - Fax:
Practice Address - Street 1:36101 BOB HOPE DR STE A
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2001
Practice Address - Country:US
Practice Address - Phone:760-321-1315
Practice Address - Fax:760-321-1094
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1086068363A00000X
CA57555363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant