Healthcare Provider Details

I. General information

NPI: 1073320354
Provider Name (Legal Business Name): MEDICUS OPTIMUS MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35410 DEL REY
DANA POINT CA
92624-1814
US

IV. Provider business mailing address

1 HOAG DR
NEWPORT BEACH CA
92663-4162
US

V. Phone/Fax

Practice location:
  • Phone: 801-330-9242
  • Fax:
Mailing address:
  • Phone: 801-330-9242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NATHAN GILMORE
Title or Position: PRESIDENT
Credential: MD
Phone: 801-330-9242