Provider Demographics
NPI:1881635688
Name:OMSKI, JOLANTA M (MD)
Entity Type:Individual
Prefix:MS
First Name:JOLANTA
Middle Name:M
Last Name:OMSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 CAMINO RAMON
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4440
Mailing Address - Country:US
Mailing Address - Phone:925-866-1005
Mailing Address - Fax:925-866-1006
Practice Address - Street 1:2301 CAMINO RAMON
Practice Address - Street 2:SUITE 180
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4440
Practice Address - Country:US
Practice Address - Phone:925-866-1005
Practice Address - Fax:925-866-1006
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A817220Medicare ID - Type UnspecifiedMEDICARE
CAH98152Medicare UPIN