Healthcare Provider Details

I. General information

NPI: 1750178083
Provider Name (Legal Business Name): NAJIBULLAH OMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9412 BIG HORN BLVD STE 6
ELK GROVE CA
95758-1101
US

IV. Provider business mailing address

9241 BRUCEVILLE RD APT 162
ELK GROVE CA
95758-5936
US

V. Phone/Fax

Practice location:
  • Phone: 916-879-2387
  • Fax:
Mailing address:
  • Phone: 916-839-9698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: