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General NPI Number Information
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NPI Number | 1598033078
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Entity Type | Organization
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Legal Business Name | OMNI WOMEN'S HEALTH MEDICAL GROUP
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 3612 N. FIRST ST.
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City | FRESNO
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State | CA
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Zip | 93726
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Country | US
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Telephone | 559-495-3120
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Fax |
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Provider Business Mailing Address
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Address Line | 3612 N. FIRST ST.
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City | FRESNO
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State | CA
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Zip | 93726
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Country | US
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Telephone | 559-495-3120
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROBERT FREDIANI
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Credential |
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Telephone | 559-495-3120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA21435
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License Number State | CA
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