Provider Demographics
NPI:1518306802
Name:KHALIFA AL OMRANI, BAKR (MD)
Entity Type:Individual
Prefix:
First Name:BAKR
Middle Name:
Last Name:KHALIFA AL OMRANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BAKR
Other - Middle Name:BASHEER
Other - Last Name:KHALIFA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:26520 CACTUS AVE
Mailing Address - Street 2:FAMILY MEDICINE DEPT
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-3927
Mailing Address - Country:US
Mailing Address - Phone:951-486-5611
Mailing Address - Fax:951-486-5620
Practice Address - Street 1:26520 CACTUS AVE
Practice Address - Street 2:FAMILY MEDICINE CLINIC
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3927
Practice Address - Country:US
Practice Address - Phone:951-486-5593
Practice Address - Fax:951-486-5595
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA138506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine