Provider Demographics
NPI:1609975010
Name:OPTIMA INFUSION PHARMACY INC
Entity Type:Organization
Organization Name:OPTIMA INFUSION PHARMACY INC
Other - Org Name:OPTIMA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIELY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:787-883-5959
Mailing Address - Street 1:HC 3 BOX 7525
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-9539
Mailing Address - Country:US
Mailing Address - Phone:787-883-5959
Mailing Address - Fax:787-883-6040
Practice Address - Street 1:CARR 2 KM 26.2
Practice Address - Street 2:ESPINOSA WARD
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-883-5959
Practice Address - Fax:787-883-6042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251F00000X, 261QI0500X
PR332B00000X
PR07F2314333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5628110001Medicare ID - Type Unspecified