Provider Demographics
NPI:1134152747
Name:OMAR, MARLA (DC)
Entity type:Individual
Prefix:DR
First Name:MARLA
Middle Name:
Last Name:OMAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PIERRE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789
Mailing Address - Country:US
Mailing Address - Phone:909-594-6181
Mailing Address - Fax:909-594-6120
Practice Address - Street 1:100 PIERRE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789
Practice Address - Country:US
Practice Address - Phone:909-594-6181
Practice Address - Fax:909-594-6120
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25484OtherBOARD OF CHIROPRACTIC
U72819Medicare UPIN
CAU72819Medicare ID - Type Unspecified