Organization
OMNI MEDICAL GROUP LLC
Active
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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