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General NPI Number Information
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NPI Number | 1063569614
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Entity Type | Organization
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Legal Business Name | OMNI MEDICAL HEALTH GROUP INC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 12/20/2010
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Provider Practice Location Address
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Address Line | 1159 S LORENA ST
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City | LOS ANGELES
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State | CA
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Zip | 90023-2926
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Country | US
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Telephone | 323-881-6465
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Fax | 323-261-8768
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Provider Business Mailing Address
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Address Line | PO BOX 479
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City | MONTEREY PARK
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State | CA
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Zip | 91754-0479
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Country | US
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Telephone | 323-881-6465
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Fax | 323-261-8768
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANASSEH C NWAIGWE
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Credential | M.D.
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Telephone | 323-881-6465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A42532
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License Number State | CA
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