Provider Demographics
NPI:1518374156
Name:OPTIMAL HEALTHCARE SOLUTIONS
Entity Type:Organization
Organization Name:OPTIMAL HEALTHCARE SOLUTIONS
Other - Org Name:OPTIMAL WELLNESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHEIRNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEP-KWEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-861-3164
Mailing Address - Street 1:4200 TRABUCO RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3600
Mailing Address - Country:US
Mailing Address - Phone:949-861-3170
Mailing Address - Fax:949-861-3179
Practice Address - Street 1:4200 TRABUCO RD STE 190
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3659
Practice Address - Country:US
Practice Address - Phone:949-861-3170
Practice Address - Fax:949-861-3179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY519813336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149234OtherPK
CA1518374156Medicaid