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General NPI Number Information
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NPI Number | 1306172945
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Entity Type | Individual
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Provider Name | OMAR STEVEN ARRIETA M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2009
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Last Update Date | 09/17/2021
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Provider Practice Location Address
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Address Line | SCOTT & WHITE 4 SOUTH PEDI ADMINISTRATION RM 431 2401 SOUTH 31ST STREET
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City | TEMPLE
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State | TX
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Zip | 76508-0001
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Country | US
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Telephone | 254-724-4363
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Fax |
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Provider Business Mailing Address
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Address Line | 805 1/2 S MAIN ST
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City | GEORGETOWN
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State | TX
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Zip | 78626-5826
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Country | US
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Telephone | 412-983-5364
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | N4260
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | TEMP MED LICENSE
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License Number State | TX
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