Healthcare Provider Details

I. General information

NPI: 1760993596
Provider Name (Legal Business Name): OMNI FAMILY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 PANAMA LN UNIT 102B
BAKERSFIELD CA
93313-3511
US

IV. Provider business mailing address

4900 CALIFORNIA AVE 400B
BAKERSFIELD CA
93309-7081
US

V. Phone/Fax

Practice location:
  • Phone: 661-630-7732
  • Fax: 661-630-7734
Mailing address:
  • Phone: 661-459-1900
  • Fax: 661-459-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANCISCO L CASTILLON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 661-630-7050