Provider Demographics
NPI:1730114331
Name:OPTIMUM MEDICAL CENTER INC
Entity Type:Organization
Organization Name:OPTIMUM MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PIEDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-662-4005
Mailing Address - Street 1:7575 SW 62ND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4955
Mailing Address - Country:US
Mailing Address - Phone:305-662-4005
Mailing Address - Fax:305-557-9030
Practice Address - Street 1:7575 SW 62ND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4955
Practice Address - Country:US
Practice Address - Phone:305-662-4005
Practice Address - Fax:305-557-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686869Medicare PIN