Provider Demographics
NPI:1821083965
Name:CINDY WIEMANN
Entity Type:Organization
Organization Name:CINDY WIEMANN
Other - Org Name:OMNI MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WIEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-598-8419
Mailing Address - Street 1:9272 JERONIMO RD
Mailing Address - Street 2:ST#120
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1913
Mailing Address - Country:US
Mailing Address - Phone:949-598-8419
Mailing Address - Fax:949-598-8420
Practice Address - Street 1:9272 JERONIMO RD
Practice Address - Street 2:ST#120
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-1913
Practice Address - Country:US
Practice Address - Phone:949-598-8419
Practice Address - Fax:949-598-8420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100528332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME020128FMedicaid
CADME020128FMedicaid