1912126046 NPI number — OMNI FAMILY HEALTH

Table of content: (NPI 1912126046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912126046 NPI number — OMNI FAMILY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OMNI FAMILY HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912126046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 N MILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEHACHAPI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-459-1900
Provider Business Practice Location Address Fax Number:
661-459-1974
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CASTILLON
Authorized Official First Name:
FRANCISCO
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIEF EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
661-630-7050

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  550000030 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X , with the licence number: 550000030 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHA322610 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: FHC71079F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ13786Z . This is a "MEDICARE PART B" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HAP71079F . This is a "FAMILY PACT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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