Organization
OMNI MEDICAL GROUP LLC
Active
Other names
Clinica La Esperanza
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OLENA DZIUBA (CFO)
(505) 573-2495
Entity
Organization
Contact information
Practice address
4201 CENTRAL AVE NW, K3, ALBUQUERQUE, NM 87105-1630
(505) 717-1685
Mailing address
4201 CENTRAL AVE NW, STE K3, ALBUQUERQUE, NM 87105-1630
(505) 508-1739
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
6556
NM
207Q00000X
Family Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
363AM0700X
Medical Physician Assistant
PA20030032
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5126223
—
NM
Enumeration date
02/01/2011
Last updated
01/19/2015
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