Provider Demographics
NPI:1952829376
Name:OMANDAC, SYMOUR SR
Entity Type:Individual
Prefix:
First Name:SYMOUR
Middle Name:
Last Name:OMANDAC
Suffix:SR
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 1:5000 W OAKEY BLVD STE A7
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3394
Mailing Address - Country:US
Mailing Address - Phone:702-242-4663
Mailing Address - Fax:702-242-4662
Practice Address - Street 1:5000 W OAKEY BLVD STE A7
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3394
Practice Address - Country:US
Practice Address - Phone:702-242-4663
Practice Address - Fax:702-242-4662
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily