Healthcare Provider Details

I. General information

NPI: 1982936779
Provider Name (Legal Business Name): OMAR SAIF MAPARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6452 BUENA VISTA DR UNIT #C
NEWARK CA
94560-5319
US

IV. Provider business mailing address

6452 BUENA VISTA DR UNIT #C
NEWARK CA
94560-5319
US

V. Phone/Fax

Practice location:
  • Phone: 310-895-4340
  • Fax:
Mailing address:
  • Phone: 310-895-4340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA110851
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: