Healthcare Provider Details

I. General information

NPI: 1205367646
Provider Name (Legal Business Name): OMNI FAMILY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4844 N 1ST ST STE 104
FRESNO CA
93726-0529
US

IV. Provider business mailing address

4900 CALIFORNIA AVE 400B
BAKERSFIELD CA
93309-7081
US

V. Phone/Fax

Practice location:
  • Phone: 866-707-6664
  • Fax: 661-746-9197
Mailing address:
  • Phone: 661-459-1900
  • Fax: 661-746-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. FRANCISCO L CASTILLON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 661-630-7045