Healthcare Provider Details

I. General information

NPI: 1396721197
Provider Name (Legal Business Name): OMNI WOMENS HEALTH MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 N 1ST ST
FRESNO CA
93726-4301
US

IV. Provider business mailing address

3812 N 1ST ST
FRESNO CA
93726-4301
US

V. Phone/Fax

Practice location:
  • Phone: 559-495-3120
  • Fax: 559-495-3134
Mailing address:
  • Phone: 559-495-3120
  • Fax: 559-495-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FENGLALY CHERTA LEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-495-3120