Provider Demographics
NPI:1023526993
Name:OPTIMAL HEALTH OF CA III,LLC
Entity type:Organization
Organization Name:OPTIMAL HEALTH OF CA III,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING AND CREDENTIALING LEAD
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ESME
Authorized Official - Last Name:ROBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-557-2352
Mailing Address - Street 1:102 WOODMONT BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2216
Mailing Address - Country:US
Mailing Address - Phone:615-812-0287
Mailing Address - Fax:833-904-0120
Practice Address - Street 1:8939 S SEPULVEDA BLVD STE 102B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3605
Practice Address - Country:US
Practice Address - Phone:615-386-0064
Practice Address - Fax:615-386-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-13
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty