Active NPI
Omni Medical Health Group Inc
- Family Medicine Physician
- Los Angeles, CA
National Provider Identifier
1063569614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- A42532
- Legal business name
- OMNI MEDICAL HEALTH GROUP INC
- Practice address
- 1159 S Lorena St
Los Angeles, CA 90023-2926 - Phone
- (323) 881-6465
- Fax
- (323) 261-8768
- NPI assigned
- Jan 5, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Manasseh C Nwaigwe, M.D.
- Title
- President
- Phone
- (323) 881-6465
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A42532 | CA | Primary |
Addresses
Primary practice location
1159 S Lorena St
Los Angeles, CA 90023-2926
Mailing address
PO Box 479
Monterey Park, CA 91754-0479
Phone (323) 881-6465
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A425320 | Medicaid | CA | |
| AV913 | Other | CA | PTAN |
| 1063569614 | Other | CA | NPI |
| AV913 | Other | CA | MEDICARE PTAN |
| AV913A | Other | CA | PTAN |
National Provider Directory
National Provider DirectoryLocations
1159 S Lorena St
Los Angeles, CA 90023
Phone (323) 881-6465
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1292803200000",
"number": "1063569614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 479",
"city": "MONTEREY PARK",
"state": "CA",
"postal_code": "917540479",
"telephone_number": "323-881-6465",
"fax_number": "323-261-8768"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1159 S LORENA ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900232926",
"telephone_number": "323-881-6465",
"fax_number": "323-261-8768"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OMNI MEDICAL HEALTH GROUP INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-05",
"last_updated": "2010-12-20",
"status": "A",
"authorized_official_last_name": "NWAIGWE",
"authorized_official_first_name": "MANASSEH",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "323-881-6465",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "CA",
"license": "A42532",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A425320",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "AV913",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1063569614",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "AV913",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "AV913A",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.