Basic Information
| Provider Information | |||||||||
| NPI: | 1558081042 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OMNI FAMILY HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4900 CALIFORNIA AVENUE, SUITE 400B | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933097081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614591900 | ||||||||
| FaxNumber: | 6614591944 | ||||||||
| Practice Location | |||||||||
| Address1: | 2107 7TH STREET | ||||||||
| Address2: | |||||||||
| City: | WASCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932801502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667076664 | ||||||||
| FaxNumber: | 6617469197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2022 | ||||||||
| LastUpdateDate: | 09/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | CASTILLON | ||||||||
| AuthorizedOfficialFirstName: | FRANCISCO | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6616307050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | WC33511 | 05 | CA | MEDICAID |