Healthcare Provider Details

I. General information

NPI: 1356737621
Provider Name (Legal Business Name): OMNI FAMILY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S CENTRAL VALLEY HWY
SHAFTER CA
93263-2790
US

IV. Provider business mailing address

655 S CENTRAL VALLEY HWY
SHAFTER CA
93263-2790
US

V. Phone/Fax

Practice location:
  • Phone: 661-746-9194
  • Fax: 661-746-9197
Mailing address:
  • Phone: 661-746-9194
  • Fax: 661-746-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number19288
License Number StateCA

VIII. Authorized Official

Name: MRS. PATRICIA A MEDINA
Title or Position: REGISTERED DENTAL HYGIENIST
Credential: R.D.H.
Phone: 661-303-9611