Provider Demographics
NPI:1205697117
Name:LONGORIA, OMAR DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:DAVID
Last Name:LONGORIA
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:8333 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6049
Mailing Address - Country:US
Mailing Address - Phone:850-474-8591
Mailing Address - Fax:850-474-8083
Practice Address - Street 1:8333 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6049
Practice Address - Country:US
Practice Address - Phone:850-474-8591
Practice Address - Fax:850-474-8083
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-07-25
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant