Organization
ALPHA OMEGA IOM A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER SMITH MD (OWNER)
(916) 352-0016
Entity
Organization
Contact information
Practice address
5 MEDICAL PLAZA DR STE 120B, ROSEVILLE, CA 95661-2866
(916) 352-0016
Mailing address
5 MEDICAL PLAZA DR STE 120B, ROSEVILLE, CA 95661-2866
(916) 352-0016
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
2084N0400X
Neurology Physician
—
—
231H00000X
Audiologist
—
—
2355A2700X
Audiology Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A108880
CA LICENSE
CA
Enumeration date
05/02/2022
Last updated
05/02/2022
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