Provider Demographics
NPI:1235380007
Name:OPTIMA MEDICAL CARE, LLC
Entity Type:Organization
Organization Name:OPTIMA MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-220-4392
Mailing Address - Street 1:8575 E PRINCESS DR STE 117
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5437
Mailing Address - Country:US
Mailing Address - Phone:480-889-1961
Mailing Address - Fax:480-264-7012
Practice Address - Street 1:8575 E PRINCESS DR STE 117
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5437
Practice Address - Country:US
Practice Address - Phone:480-889-1961
Practice Address - Fax:480-264-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51955207R00000X
208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty