Healthcare Provider Details

I. General information

NPI: 1881635688
Provider Name (Legal Business Name): JOLANTA M OMSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 01/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 CAMINO RAMON SUITE 180
SAN RAMON CA
94583-4440
US

IV. Provider business mailing address

2301 CAMINO RAMON SUITE 180
SAN RAMON CA
94583-4440
US

V. Phone/Fax

Practice location:
  • Phone: 925-866-1005
  • Fax: 925-866-1006
Mailing address:
  • Phone: 925-866-1005
  • Fax: 925-866-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA81722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: