Provider Demographics
NPI:1891323960
Name:MUSA, OMAR (FNP-C)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:MUSA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 EVANS ROAD
Mailing Address - Street 2:
Mailing Address - City:WOFFORD HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:93285-9640
Mailing Address - Country:US
Mailing Address - Phone:760-376-2276
Mailing Address - Fax:760-376-4801
Practice Address - Street 1:67 EVANS ROAD
Practice Address - Street 2:
Practice Address - City:WOFFORD HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:93285-9640
Practice Address - Country:US
Practice Address - Phone:760-376-2276
Practice Address - Fax:760-376-4801
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATHP11576FMedicaid