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NPI Code Detail

MEDICARE: ROBERT JAMES OMALLEY NP

MEDICARE: ROBERT JAMES OMALLEY NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerNPF9564CA

General Provider Information

NPI Number : 1609872001
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT JAMES OMALLEY NP
Provider Business Mailing Address
First Line : 1709 COSTA VERDE ST
Second Line :
City : DAVIS
State : CA
Zip : 95618-6549
Country : US
Telephone Number : 530-756-3924
Fax Number :
Provider Business Practice Location Address
First Line : 2315 STOCKTON BLVD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95817-2201
Country : US
Telephone Number : 916-734-5538
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 03/26/2008

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