Healthcare Provider Details

I. General information

NPI: 1164902565
Provider Name (Legal Business Name): OPTIMUM PODIATRY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16815 VON KARMAN AVE STE 160
IRVINE CA
92606-2420
US

IV. Provider business mailing address

909 TOLLIS PKWY
BROADVIEW HEIGHTS OH
44147-1818
US

V. Phone/Fax

Practice location:
  • Phone: 714-404-5641
  • Fax:
Mailing address:
  • Phone: 714-404-5641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: JONATHAN MATTHEW MOSS
Title or Position: OWNER
Credential: DPM
Phone: 714-404-5641