Provider Demographics
NPI:1467653774
Name:OMNI WOMENS HEALTH ULTRASOUND
Entity Type:Organization
Organization Name:OMNI WOMENS HEALTH ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-495-3120
Mailing Address - Street 1:5771 N FRESNO ST STE 109
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6091
Mailing Address - Country:US
Mailing Address - Phone:559-441-4273
Mailing Address - Fax:559-495-3134
Practice Address - Street 1:5771 N FRESNO ST STE 109
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6091
Practice Address - Country:US
Practice Address - Phone:559-441-4273
Practice Address - Fax:559-495-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGR0068489261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0068489Medicaid
CAGR0068489Medicaid