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NPI Code Detail

MEDICARE: ROBERT JOHN O'MARA PA-C

MEDICARE: ROBERT JOHN O'MARA PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA14526CA

General Provider Information

NPI Number : 1336174382
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT JOHN O'MARA PA-C
Provider Business Mailing Address
First Line : 823 GATEWAY CENTER WAY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-4541
Country : US
Telephone Number : 619-906-4623
Fax Number : 619-906-4564
Provider Business Practice Location Address
First Line : 1809 NATIONAL AVENUE
Second Line : LOGAN HEIGHTS FAMILY HEALTH CENTER
City : SAN DIEGO
State : CA
Zip : 92113-2196
Country : US
Telephone Number : 619-515-2300
Fax Number : 619-234-2447
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 10/14/2013

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