Provider Demographics
NPI:1730322207
Name:OPTIMUM FITNESS & HEALTH
Entity Type:Organization
Organization Name:OPTIMUM FITNESS & HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:BILLING SPECIALIST
Authorized Official - Phone:858-943-1814
Mailing Address - Street 1:7744 FAY AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4313
Mailing Address - Country:US
Mailing Address - Phone:858-459-0180
Mailing Address - Fax:858-459-4858
Practice Address - Street 1:7744 FAY AVE
Practice Address - Street 2:STE 100
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4313
Practice Address - Country:US
Practice Address - Phone:858-459-0180
Practice Address - Fax:858-459-4858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty