Provider Demographics
NPI:1487021804
Name:ALCANTAR, OMAR
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:ALCANTAR
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 1:339 PAJARO ST. SUITE D
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901
Mailing Address - Country:US
Mailing Address - Phone:831-800-7530
Mailing Address - Fax:831-975-5862
Practice Address - Street 1:339 PAJARO ST. SUITE D
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901
Practice Address - Country:US
Practice Address - Phone:831-800-7530
Practice Address - Fax:831-975-5862
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health