Provider Demographics
NPI:1194367326
Name:OMNI FAMILY HEALTH
Entity type:Organization
Organization Name:OMNI FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASTILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-630-7050
Mailing Address - Street 1:4900 CALIFORNIA AVE
Mailing Address - Street 2:SUITE 400B
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-7081
Mailing Address - Country:US
Mailing Address - Phone:661-459-1900
Mailing Address - Fax:661-459-1944
Practice Address - Street 1:912 FREMONT STREET
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2203
Practice Address - Country:US
Practice Address - Phone:661-459-1900
Practice Address - Fax:661-459-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW33511Medicaid