Provider Demographics
NPI:1013526862
Name:MY OPTIMAL LIFE
Entity Type:Organization
Organization Name:MY OPTIMAL LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BROSSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-691-2069
Mailing Address - Street 1:72301 COUNTRY CLUB DR STE 105
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-8007
Mailing Address - Country:US
Mailing Address - Phone:706-567-8207
Mailing Address - Fax:
Practice Address - Street 1:72301 COUNTRY CLUB DR STE 105
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-8007
Practice Address - Country:US
Practice Address - Phone:760-691-2069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty