Provider Demographics
NPI:1609211457
Name:AN OPTIMAL YOU
Entity Type:Organization
Organization Name:AN OPTIMAL YOU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANSCET
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-461-3021
Mailing Address - Street 1:29995 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2632
Mailing Address - Country:US
Mailing Address - Phone:951-461-3021
Mailing Address - Fax:951-461-8898
Practice Address - Street 1:29995 TECHNOLOGY DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2632
Practice Address - Country:US
Practice Address - Phone:951-461-3021
Practice Address - Fax:951-461-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service