MEDICARE: OMNI FAMILY HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center	120000654	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	ZZZ03011Z	OTHER		MEDICARE PART B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	HAP70972F	OTHER	FAMILY PACT
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134340250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNI FAMILY HEALTH

Provider Business Mailing Address
First Line	:	4900 CALIFORNIA AVENUE
Second Line	:	400B
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-7081
Country	:	US
Telephone Number	:	661-459-1900
Fax Number	:	661-459-1974

Provider Business Practice Location Address
First Line	:	1215 JEFFERSON ST
Second Line	:
City	:	DELANO
State	:	CA
Zip	:	93215-2203
Country	:	US
Telephone Number	:	661-459-1900
Fax Number	:	661-459-1974

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. FRANCISCO L CASTILLON
Credential	:
Telephone Number	:	661-630-7050

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	08/09/2018

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1619025152 — MRS. VERONICA DURAN-PEREZ FNP
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1851588297 — DR. GUIA CARDENAS TADLE DDS
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Directions to “OMNI FAMILY HEALTH ” Practice Location

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