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General NPI Number Information
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NPI Number | 1023996824
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Entity Type | Individual
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Provider Name | BANDAR KHALED AL-OMAIRA
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Gender | Male
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 1355 INDUSTRIAL AVE
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City | PETALUMA
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State | CA
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Zip | 94952-6500
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Country | US
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Telephone | 707-736-0690
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Fax |
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Provider Business Mailing Address
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Address Line | 695 CLAUDIUS WAY
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City | WINDSOR
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State | CA
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Zip | 95492-8532
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Country | US
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Telephone | 559-304-0833
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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