Provider Demographics
NPI:1710500962
Name:FATIMA HEALTH LLC
Entity Type:Organization
Organization Name:FATIMA HEALTH LLC
Other - Org Name:OPTIMAL HEALTH MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-910-3171
Mailing Address - Street 1:855 E BROWN RD STE 10
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-4949
Mailing Address - Country:US
Mailing Address - Phone:623-910-3171
Mailing Address - Fax:949-655-2754
Practice Address - Street 1:855 E BROWN RD STE 10
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-4949
Practice Address - Country:US
Practice Address - Phone:623-910-3171
Practice Address - Fax:949-655-2754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty