Healthcare Provider Details

I. General information

NPI: 1386308393
Provider Name (Legal Business Name): MR. OMAR FARAG EZUBEIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 36TH ST
SACRAMENTO CA
95817-1308
US

IV. Provider business mailing address

2008 36TH ST
SACRAMENTO CA
95817-1308
US

V. Phone/Fax

Practice location:
  • Phone: 209-298-2050
  • Fax:
Mailing address:
  • Phone: 209-298-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA203280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: