Provider Demographics
NPI:1790563260
Name:OPTIMAL BODY NURSING CENTER, INC.
Entity Type:Organization
Organization Name:OPTIMAL BODY NURSING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:REZENDE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:818-470-2848
Mailing Address - Street 1:23861 MCBEAN PKWY STE A4
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2003
Mailing Address - Country:US
Mailing Address - Phone:661-388-0339
Mailing Address - Fax:
Practice Address - Street 1:23861 MCBEAN PKWY STE A4
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-2003
Practice Address - Country:US
Practice Address - Phone:661-388-0339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty