Healthcare Provider Details

I. General information

NPI: 1396212122
Provider Name (Legal Business Name): ELHAAM OMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ILENE ST
MARTINEZ CA
94553-2631
US

IV. Provider business mailing address

1080 MARINA VILLAGE PKWY STE 100
ALAMEDA CA
94501-1078
US

V. Phone/Fax

Practice location:
  • Phone: 925-313-7080
  • Fax:
Mailing address:
  • Phone: 510-337-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161926
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: