Individual provider Active NPI

Laura Ehab Omar, LCSW

  • Social Worker
  • Pacoima, CA
National Provider Identifier
1508199472
Registry record updated Jul 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
LCS29672 Issued in CA
Practice address
12450 Van Nuys Blvd Ste 200
Pacoima, CA 91331
Phone
(818) 896-1161
Fax
(818) 896-5069
NPI assigned
Sep 10, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X LCS29672 CA Primary

Addresses

Primary practice location

12450 Van Nuys Blvd Ste 200
Pacoima, CA 91331

Mailing address

12450 Van Nuys Blvd Ste 200
Pacoima, CA 91331-1393
Phone (818) 896-1161

Other practice location 1

940 Avenue 64
Pasadena, CA 91105
Phone (323) 254-2274

Other identifiers 3

IdentifierTypeStateIssuer
6758MedicaidCA
7068MedicaidCA
7420MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCS29672CAMDSocial Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531699200000",
    "number": "1508199472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12450 VAN NUYS BLVD STE 200",
            "city": "PACOIMA",
            "state": "CA",
            "postal_code": "913311393",
            "telephone_number": "818-896-1161",
            "fax_number": "818-896-5069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12450 VAN NUYS BLVD STE 200",
            "city": "PACOIMA",
            "state": "CA",
            "postal_code": "91331",
            "telephone_number": "818-896-1161",
            "fax_number": "818-896-5069"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "940 Avenue 64",
            "address_purpose": "LOCATION",
            "city": "Pasadena",
            "state": "CA",
            "postal_code": "91105",
            "country_code": "US",
            "telephone_number": "323-254-2274",
            "fax_number": "323-254-9087",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OMAR",
        "first_name": "LAURA",
        "middle_name": "EHAB",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-10",
        "last_updated": "2018-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "LCS29672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6758",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7068",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7420",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pacoima, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.