Provider Demographics
NPI:1235879263
Name:GOMEZ ESTRADA, OMAR NOE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:NOE
Last Name:GOMEZ ESTRADA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 AGNEW ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1917
Mailing Address - Country:US
Mailing Address - Phone:805-304-9875
Mailing Address - Fax:
Practice Address - Street 1:99 N LA CIENEGA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2285
Practice Address - Country:US
Practice Address - Phone:805-304-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist