Provider Demographics
NPI:1093885980
Name:OMNI MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:OMNI MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NARASIMHA
Authorized Official - Middle Name:P
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-778-7147
Mailing Address - Street 1:1180 N INDIAN CANYON DR STE E319
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4809
Mailing Address - Country:US
Mailing Address - Phone:760-778-7147
Mailing Address - Fax:760-416-5025
Practice Address - Street 1:7281 DUMOSA AVE STE 2
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3781
Practice Address - Country:US
Practice Address - Phone:760-365-2722
Practice Address - Fax:760-365-5099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI34966Medicare UPIN
CAZZZ16524ZMedicare ID - Type Unspecified
CA00A901190Medicare PIN