Provider Demographics
NPI:1700804556
Name:OMNI FAMILY HEALTH
Entity Type:Organization
Organization Name:OMNI FAMILY HEALTH
Other - Org Name:NATIONAL HEALTH SERVICES, INC
Other - Org Type:Former Legal Business Name
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 2:400B
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:661-746-9197
Practice Address - Street 1:525 ROBERTS LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-4799
Practice Address - Country:US
Practice Address - Phone:661-392-7850
Practice Address - Fax:661-746-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000668261QF0400X
CACLP320413291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABCP71019FOtherCDHS
CAFHC71019FMedicaid
CAHAP71019FOtherDHCS/FAMILY PACT
CA4442635Medicare PIN
CA051080Medicare Oscar/Certification
051080Medicare Oscar/Certification
CAW33511Medicare UPIN