Provider Demographics
NPI:1265616429
Name:OMAR TIRMIZI, MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:OMAR TIRMIZI, MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIMIZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-556-0702
Mailing Address - Street 1:9808 VENICE BLVD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2732
Mailing Address - Country:US
Mailing Address - Phone:310-556-0702
Mailing Address - Fax:310-556-8464
Practice Address - Street 1:9808 VENICE BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2732
Practice Address - Country:US
Practice Address - Phone:310-556-0702
Practice Address - Fax:310-556-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53175207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG53139Medicare UPIN
CAW22632Medicare PIN