Provider Demographics
NPI:1386673077
Name:CENTERS FOR OPTIMAL WELLNESS
Entity Type:Organization
Organization Name:CENTERS FOR OPTIMAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:714-563-1805
Mailing Address - Street 1:751 S WEIR CANYON RD
Mailing Address - Street 2:SUITE 157633
Mailing Address - City:ANAHEIM HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92808
Mailing Address - Country:US
Mailing Address - Phone:951-371-1331
Mailing Address - Fax:951-371-0331
Practice Address - Street 1:934 S EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-1523
Practice Address - Country:US
Practice Address - Phone:714-563-1805
Practice Address - Fax:714-446-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19590Medicare ID - Type Unspecified