Provider Demographics
NPI:1407187198
Name:OPTIMUM HEALTH CARE
Entity Type:Organization
Organization Name:OPTIMUM HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:JORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-744-1577
Mailing Address - Street 1:PMB 2085 PO BOX 4956
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4956
Mailing Address - Country:US
Mailing Address - Phone:787-744-1577
Mailing Address - Fax:787-286-0536
Practice Address - Street 1:V43 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6486
Practice Address - Country:US
Practice Address - Phone:787-744-1577
Practice Address - Fax:787-286-0536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11848261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service