1649581679 NPI number — OMAR ARAFAT M.D.

Table of content: OMAR ARAFAT M.D. (NPI 1649581679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649581679 NPI number — OMAR ARAFAT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARAFAT
Provider First Name:
OMAR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649581679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
757 WESTWOOD PLAZA, STE 1638
Provider Second Line Business Mailing Address:
UCLA RADIOLOGY
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90095
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-267-8758
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2428 SANTA MONICA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90404-2045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-315-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  A105581 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085B0100X , with the licence number: A105581 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0A1055810 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 123304700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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