Healthcare Provider Details

I. General information

NPI: 1811809635
Provider Name (Legal Business Name): OMNI HEALTH MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10324 BALBOA BLVD
GRANADA HILLS CA
91344-7349
US

IV. Provider business mailing address

10324 BALBOA BLVD
GRANADA HILLS CA
91344-7349
US

V. Phone/Fax

Practice location:
  • Phone: 818-620-0618
  • Fax:
Mailing address:
  • Phone: 818-620-0618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE RONGEY
Title or Position: CEO OWNER
Credential:
Phone: 818-620-0618