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General NPI Number Information
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NPI Number | 1568850576
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Entity Type | Organization
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Legal Business Name | JOEL OMBAO INC.
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Dates
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Enumeration Date | 12/26/2014
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Last Update Date | 12/26/2014
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Provider Practice Location Address
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Address Line | 1121 AMBERWOOD CT
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-4126
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Country | US
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Telephone | 909-800-0883
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 AMBERWOOD CT
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-4126
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Country | US
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Telephone | 909-800-0883
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOEL G OMBAO
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Credential | NP
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Telephone | 909-800-0883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 22676
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License Number State | CA
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