Healthcare Provider Details

I. General information

NPI: 1326943465
Provider Name (Legal Business Name): OPTIMAL HEALING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22024 LASSEN ST STE 123
CHATSWORTH CA
91311-8330
US

IV. Provider business mailing address

22024 LASSEN ST STE 123
CHATSWORTH CA
91311-8330
US

V. Phone/Fax

Practice location:
  • Phone: 123-456-7890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. KRISTINE MIRZOYAN
Title or Position: OWNER
Credential:
Phone: 123-456-7890