Provider Demographics
NPI:1235774597
Name:ELHADAD, OMAR E
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:E
Last Name:ELHADAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3687 HEINDON RD
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4572
Mailing Address - Country:US
Mailing Address - Phone:949-870-5715
Mailing Address - Fax:
Practice Address - Street 1:3960 WALNUT DR
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-8938
Practice Address - Country:US
Practice Address - Phone:707-268-8722
Practice Address - Fax:707-268-0218
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician