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General NPI Number Information
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NPI Number | 1093885980
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Entity Type | Organization
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Legal Business Name | OMNI MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 7281 DUMOSA AVE STE 2
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-3781
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Country | US
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Telephone | 760-365-2722
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Fax | 760-365-5099
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Provider Business Mailing Address
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Address Line | 1180 N INDIAN CANYON DR STE E319
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City | PALM SPRINGS
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State | CA
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Zip | 92262-4809
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Country | US
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Telephone | 760-778-7147
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Fax | 760-416-5025
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Authorized Official
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Title or Position | OWNER
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Name | NARASIMHA P RAO
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Credential | M.D.
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Telephone | 760-778-7147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | CA
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