Provider Demographics
NPI:1609383363
Name:FIRST STEP OPTIMAL HEALTH CORPORATION
Entity Type:Organization
Organization Name:FIRST STEP OPTIMAL HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WAITS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-322-3124
Mailing Address - Street 1:17290 JASMINE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8300
Mailing Address - Country:US
Mailing Address - Phone:760-951-2400
Mailing Address - Fax:951-840-2088
Practice Address - Street 1:17290 JASMINE ST STE 101
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8300
Practice Address - Country:US
Practice Address - Phone:760-951-2400
Practice Address - Fax:951-840-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA552070207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty