Provider Demographics
NPI:1396721197
Name:OMNI WOMENS HEALTH MEDICAL GROUP INC
Entity type:Organization
Organization Name:OMNI WOMENS HEALTH MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FENGLALY
Authorized Official - Middle Name:CHERTA
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-495-3120
Mailing Address - Street 1:3812 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4301
Mailing Address - Country:US
Mailing Address - Phone:559-495-3120
Mailing Address - Fax:559-495-3134
Practice Address - Street 1:3812 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4301
Practice Address - Country:US
Practice Address - Phone:559-495-3120
Practice Address - Fax:559-495-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0068481Medicaid
CAGR0068482Medicaid
CALAB61460FMedicaid
CAGR0068487Medicaid
CAGR0068489Medicaid
CAGR0068480Medicaid
CAGR0068488Medicaid
CAGR0068483Medicaid
CAGR0068486Medicaid
CAGR0068484Medicaid
CAGR0068485Medicaid
CAGR0068488Medicaid