MEDICARE: JOEL OMBAO INC.

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
1	363L00000X	Nurse Practitioner	22676	CA

General Provider Information

NPI Number	:	1568850576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOEL OMBAO INC.

Provider Business Mailing Address
First Line	:	1121 AMBERWOOD CT
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92407-4126
Country	:	US
Telephone Number	:	909-800-0883
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 AMBERWOOD CT
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92407-4126
Country	:	US
Telephone Number	:	909-800-0883
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOEL G OMBAO
Credential	:	NP
Telephone Number	:	909-800-0883

Provider Enumeration Date	:	12/26/2014
Last Update Date	:	12/26/2014

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