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General NPI Number Information
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NPI Number | 1891234340
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Entity Type | Individual
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Provider Name | OMAR CHRISTOPHER RAZACK PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 1500 SAN PABLO ST FL 4
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City | LOS ANGELES
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State | CA
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Zip | 90033-5313
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Country | US
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Telephone | 323-442-7400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31309
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City | LOS ANGELES
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State | CA
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Zip | 90031-0309
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Country | US
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Telephone | 323-442-7400
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 55767
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0006392
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9110188
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License Number State | FL
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