Provider Demographics
NPI:1417212465
Name:OMAN, MERY JIEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MERY
Middle Name:JIEN
Last Name:OMAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:HUI
Other - Middle Name:JIEN
Other - Last Name:OMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:333 CITY BOULEVARD WEST, SUITE 640
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-456-8934
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-8565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21333363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083641Medicaid
CAGR0083640Medicaid
CAZZZ19972ZOtherMEDICARE LEGACY NUMBER
CAZZZ20075ZOtherMEDICARE LEGACY NUMBER
CA1033418785Medicaid
CAFE354AOtherMEDICARE