Healthcare Provider Details

I. General information

NPI: 1023526993
Provider Name (Legal Business Name): OPTIMAL HEALTH OF CA III,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2018
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8939 S SEPULVEDA BLVD STE 102B
LOS ANGELES CA
90045-3605
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 350
NASHVILLE TN
37205-2216
US

V. Phone/Fax

Practice location:
  • Phone: 615-386-0064
  • Fax: 615-386-0067
Mailing address:
  • Phone: 615-812-0287
  • Fax: 833-904-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MEGAN ESME ROBSON
Title or Position: BILLING AND CREDENTIALING LEAD
Credential:
Phone: 615-557-2352