Healthcare Provider Details

I. General information

NPI: 1639073109
Provider Name (Legal Business Name): OPULISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9431 HAVEN AVE STE 100-1049
RANCHO CUCAMONGA CA
91730-5878
US

IV. Provider business mailing address

9431 HAVEN AVE SUITE 100 PMB 1049
RANCHO CUCAMONGA CA
91730
US

V. Phone/Fax

Practice location:
  • Phone: 442-473-9345
  • Fax:
Mailing address:
  • Phone: 442-473-9345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: RENITA LOIS ADIRA
Title or Position: MANAGER
Credential: SUDRC III
Phone: 442-473-9345