Provider Demographics
NPI:1326120718
Name:HOMA, EITAN (MD)
Entity Type:Individual
Prefix:
First Name:EITAN
Middle Name:
Last Name:HOMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ALFRED NOBEL DR
Mailing Address - Street 2:SUITE 245
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1838
Mailing Address - Country:US
Mailing Address - Phone:510-741-7299
Mailing Address - Fax:510-741-7493
Practice Address - Street 1:165 LYNCH CREEK WAY
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2343
Practice Address - Country:US
Practice Address - Phone:707-762-5531
Practice Address - Fax:707-762-5976
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA070012651OtherMEDICARE RAILROAD
CAA64754OtherLICENSE NUMBER
CA00A647540Medicare PIN
CA070012651OtherMEDICARE RAILROAD