Provider Demographics
NPI:1225636855
Name:OPTIMUM WELLNESS AND WEIGHT LOSS
Entity Type:Organization
Organization Name:OPTIMUM WELLNESS AND WEIGHT LOSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNAO
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAARFM
Authorized Official - Phone:949-363-3162
Mailing Address - Street 1:638 CAMINO DE LOS MARES # H130-103
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2848
Mailing Address - Country:US
Mailing Address - Phone:310-595-0679
Mailing Address - Fax:
Practice Address - Street 1:910 S EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4279
Practice Address - Country:US
Practice Address - Phone:949-363-3162
Practice Address - Fax:888-408-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center