Provider Demographics
NPI:1003504176
Name:OMAR, FAIZA A
Entity Type:Individual
Prefix:
First Name:FAIZA
Middle Name:A
Last Name:OMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5196 HAMPTON ST NE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-1370
Mailing Address - Country:US
Mailing Address - Phone:952-737-2769
Mailing Address - Fax:
Practice Address - Street 1:5196 HAMPTON ST NE
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1370
Practice Address - Country:US
Practice Address - Phone:952-737-2769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician