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General NPI Number Information
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NPI Number | 1699235952
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Entity Type | Individual
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Provider Name | OMAR ALI
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Gender | Male
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Dates
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Enumeration Date | 03/22/2019
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 540 OAK CENTRE DR STE 205
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4767
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Country | US
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Telephone | 210-858-9772
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Fax | 602-584-6240
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Provider Business Mailing Address
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Address Line | 540 OAK CENTRE DR STE 205
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4767
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Country | US
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Telephone | 210-858-9772
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 326204
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | U2768
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License Number State | TX
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