Provider Demographics
NPI:1982661427
Name:OMSTEAD, CARL A (PA-C)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:A
Last Name:OMSTEAD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 GRANT ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2266
Mailing Address - Country:US
Mailing Address - Phone:925-676-2600
Mailing Address - Fax:925-680-0212
Practice Address - Street 1:2700 GRANT ST
Practice Address - Street 2:SUITE 320
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2266
Practice Address - Country:US
Practice Address - Phone:925-676-2600
Practice Address - Fax:925-680-0212
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 12284174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA12284OtherCA. LICENSE