Provider Demographics
NPI:1609006055
Name:CONTRERAS, OMAR (RN)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 W GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7305
Mailing Address - Country:US
Mailing Address - Phone:956-583-8876
Mailing Address - Fax:956-580-2356
Practice Address - Street 1:1700 W GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-7305
Practice Address - Country:US
Practice Address - Phone:956-583-8876
Practice Address - Fax:956-580-2356
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX677161163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677161OtherRN BOARD