Healthcare Provider Details

I. General information

NPI: 1659066785
Provider Name (Legal Business Name): OPTIMAL MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7206 N MILBURN AVE # 106
FRESNO CA
93722-8450
US

IV. Provider business mailing address

7206 N MILBURN AVE # 106
FRESNO CA
93722-8450
US

V. Phone/Fax

Practice location:
  • Phone: 559-840-0066
  • Fax: 559-272-0479
Mailing address:
  • Phone: 559-840-0066
  • Fax: 559-272-0479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLI VINUELA
Title or Position: OFFICE MANAGER
Credential:
Phone: 559-908-8158