Provider Demographics
NPI:1972036796
Name:OPTIMALCARE REHAB,LLC
Entity Type:Organization
Organization Name:OPTIMALCARE REHAB,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:808-321-6280
Mailing Address - Street 1:1712 LILIHA ST STE 302
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3100
Mailing Address - Country:US
Mailing Address - Phone:808-321-6280
Mailing Address - Fax:
Practice Address - Street 1:1712 LILIHA ST STE 302
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3100
Practice Address - Country:US
Practice Address - Phone:808-321-6280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT2421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1578609897OtherHMSA PROVIDER NUMBER 00A0251718
HI1578609897OtherHMSA PROVIDER NUMBER 00A0251718