Healthcare Provider Details

I. General information

NPI: 1710648928
Provider Name (Legal Business Name): OMEGA HEALTH CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 COFFEE RD STE 12B
MODESTO CA
95355-1751
US

IV. Provider business mailing address

PO BOX 576810
MODESTO CA
95357-6810
US

V. Phone/Fax

Practice location:
  • Phone: 209-554-4181
  • Fax:
Mailing address:
  • Phone: 209-252-6676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NANDEESH VEERAPPA
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 209-554-4181