Provider Demographics
NPI:1093142879
Name:HADDAD, OMNIA
Entity Type:Individual
Prefix:
First Name:OMNIA
Middle Name:
Last Name:HADDAD
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 1:3602 BAY TREE RD
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5655
Mailing Address - Country:US
Mailing Address - Phone:850-319-2307
Mailing Address - Fax:
Practice Address - Street 1:3602 BAY TREE RD
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-5655
Practice Address - Country:US
Practice Address - Phone:850-319-2307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography