Basic Information
| Provider Information | |||||||||
| NPI: | 1366454548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OMIDI | ||||||||
| FirstName: | SHADI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 VIA DE LA VALLE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | DEL MAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920141992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992702 | ||||||||
| FaxNumber: | 8583093119 | ||||||||
| Practice Location | |||||||||
| Address1: | 10243 GENETIC CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921216310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585262702 | ||||||||
| FaxNumber: | 8585266113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 06/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | A61775 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.