Provider Demographics
NPI:1073291993
Name:OMAR, PUSHTANA (AMFT, MS)
Entity Type:Individual
Prefix:
First Name:PUSHTANA
Middle Name:
Last Name:OMAR
Suffix:
Gender:F
Credentials:AMFT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W RIVERDALE AVE UNIT 21
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1054
Mailing Address - Country:US
Mailing Address - Phone:714-454-1354
Mailing Address - Fax:
Practice Address - Street 1:101 W RIVERDALE AVE UNIT 21
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1054
Practice Address - Country:US
Practice Address - Phone:714-454-1354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123078106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist