Healthcare Provider Details

I. General information

NPI: 1518374156
Provider Name (Legal Business Name): OPTIMAL HEALTHCARE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 TRABUCO RD STE 190
IRVINE CA
92620-3659
US

IV. Provider business mailing address

4200 TRABUCO RD SUITE 190
IRVINE CA
92620-3600
US

V. Phone/Fax

Practice location:
  • Phone: 949-861-3170
  • Fax: 949-861-3179
Mailing address:
  • Phone: 949-861-3170
  • Fax: 949-861-3179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY51981
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KATHEIRNE DIEP-KWEI
Title or Position: PRESIDENT
Credential:
Phone: 949-861-3164