Provider Demographics
NPI:1477263085
Name:INNEROPTIMAL, INC.
Entity Type:Organization
Organization Name:INNEROPTIMAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BODEMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-633-3328
Mailing Address - Street 1:2210 ENCINITAS BLVD STE L
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4376
Mailing Address - Country:US
Mailing Address - Phone:760-633-3328
Mailing Address - Fax:
Practice Address - Street 1:2210 ENCINITAS BLVD STE L
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4376
Practice Address - Country:US
Practice Address - Phone:760-633-3328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center