Provider Demographics
NPI:1750835906
Name:OPTIMUS MSO II INC
Entity Type:Organization
Organization Name:OPTIMUS MSO II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-801-1692
Mailing Address - Street 1:10899 SW 72ND ST STE 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2722
Mailing Address - Country:US
Mailing Address - Phone:786-801-1692
Mailing Address - Fax:786-801-1693
Practice Address - Street 1:10899 SW 72ND ST STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2722
Practice Address - Country:US
Practice Address - Phone:786-801-1692
Practice Address - Fax:786-801-1693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization