Healthcare Provider Details

I. General information

NPI: 1386673077
Provider Name (Legal Business Name): CENTERS FOR OPTIMAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 S EUCLID ST
ANAHEIM CA
92802-1523
US

IV. Provider business mailing address

751 S WEIR CANYON RD SUITE 157633
ANAHEIM HILLS CA
92808
US

V. Phone/Fax

Practice location:
  • Phone: 714-563-1805
  • Fax: 714-446-9366
Mailing address:
  • Phone: 951-371-1331
  • Fax: 951-371-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES J MCLAUGHLIN
Title or Position: OWNER
Credential: P.T.
Phone: 714-563-1805