Healthcare Provider Details

I. General information

NPI: 1235380007
Provider Name (Legal Business Name): OPTIMA MEDICAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8575 E PRINCESS DR STE 117
SCOTTSDALE AZ
85255-5437
US

IV. Provider business mailing address

8575 E PRINCESS DR STE 117
SCOTTSDALE AZ
85255-5437
US

V. Phone/Fax

Practice location:
  • Phone: 480-889-1961
  • Fax: 480-264-7012
Mailing address:
  • Phone: 480-889-1961
  • Fax: 480-264-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51955
License Number StateAZ

VIII. Authorized Official

Name: PAUL J SOS
Title or Position: OWNER
Credential: M.D.
Phone: 480-220-4392