Healthcare Provider Details

I. General information

NPI: 1992634315
Provider Name (Legal Business Name): OPTIMA LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4616 N 51ST AVE STE 214
PHOENIX AZ
85031-1716
US

IV. Provider business mailing address

4616 N 51ST AVE STE 214
PHOENIX AZ
85031-1716
US

V. Phone/Fax

Practice location:
  • Phone: 254-749-7016
  • Fax:
Mailing address:
  • Phone: 254-749-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KHAJA PASHA
Title or Position: OWNER
Credential:
Phone: 254-749-7016