Healthcare Provider Details

I. General information

NPI: 1073328712
Provider Name (Legal Business Name): OMAR S WESTBROOKS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 CHALLENGER DR STE 200
ALAMEDA CA
94501-1037
US

IV. Provider business mailing address

2417 ALAMEDA ST UNIT A
VALLEJO CA
94590-3303
US

V. Phone/Fax

Practice location:
  • Phone: 510-337-7198
  • Fax:
Mailing address:
  • Phone: 510-616-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15895
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number4236E30E12
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: