Individual
BAYA OMIDNIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
402 W COUNTRY CLUB RD, ROSWELL, NM 88201-5247
(575) 627-9500
(575) 627-4127
Mailing address
PO BOX 1574, ROSWELL, NM 88202-1574
(575) 627-9500
(575) 624-7537
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD2009-0514
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932187044
MEDICARE GROUP NPI
NM
05
—
41284399
—
NM
01
—
800521089
MCR GROUP
NM
01
—
Z2565
GROUP MCD
NM
Enumeration date
03/16/2009
Last updated
12/17/2021
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