Provider Demographics
NPI:1376558221
Name:OMNI FAMILY HEALTH
Entity type:Organization
Organization Name:OMNI FAMILY HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:
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 1:21138 PASO ROBLES HWY
Practice Address - Street 2:
Practice Address - City:LOST HILLS
Practice Address - State:CA
Practice Address - Zip Code:93249-0306
Practice Address - Country:US
Practice Address - Phone:866-707-6664
Practice Address - Fax:661-746-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
CA120000197261QF0400X
CACLP320413291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No1223G0001XDental ProvidersDentistGeneral Practice
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70290FMedicaid
CABCP70290FOtherCDHS
CACLP 320413Medicaid
CAHAP70290FOtherDHCS/FAMILY PACT
CAHAP70290FOtherDHCS/FAMILY PACT
CAW33511Medicare UPIN
CA051843Medicare Oscar/Certification
CAFHC70290FMedicaid