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NPI Code Detail

MEDICARE: MR. OMAR MALIK M.A.

MEDICARE: MR. OMAR MALIK M.A.
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1659521235
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. OMAR MALIK M.A.
Provider Business Mailing Address
First Line : 1313 CUTTING BLVD
Second Line :
City : RICHMOND
State : CA
Zip : 94804-2554
Country : US
Telephone Number : 510-232-8652
Fax Number :
Provider Business Practice Location Address
First Line : 1313 CUTTING BLVD
Second Line :
City : RICHMOND
State : CA
Zip : 94804-2554
Country : US
Telephone Number : 510-232-8652
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2008
Last Update Date : 09/19/2008

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