Healthcare Provider Details

I. General information

NPI: 1427220870
Provider Name (Legal Business Name): OMNI FAMILY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 07/11/2014
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

4900 CALIFORNIA AVE 400B
BAKERSFIELD CA
93309-7081
US

V. Phone/Fax

Practice location:
  • Phone: 661-746-9194
  • Fax: 661-746-9197
Mailing address:
  • Phone: 661-459-1900
  • Fax: 661-459-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLP 320413
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLP320413
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number120000652
License Number StateCA

VIII. Authorized Official

Name: MR. FRANCISCO L CASTILLON
Title or Position: CEO
Credential:
Phone: 66616307050