Provider Demographics
NPI:1457785131
Name:OPTIMAL HEALTH AND PREVENTION RESEARCH FOUNDATION
Entity Type:Organization
Organization Name:OPTIMAL HEALTH AND PREVENTION RESEARCH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:NENN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-255-6155
Mailing Address - Street 1:11199 SORRENTO VALLEY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1334
Mailing Address - Country:US
Mailing Address - Phone:858-255-6155
Mailing Address - Fax:
Practice Address - Street 1:11199 SORRENTO VALLEY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1334
Practice Address - Country:US
Practice Address - Phone:858-255-6155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty