Healthcare Provider Details

I. General information

NPI: 1376271874
Provider Name (Legal Business Name): OPT HEALTH CA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 PACIFIC AVE FL 4
SAN FRANCISCO CA
94133-4685
US

IV. Provider business mailing address

595 PACIFIC AVE FL 4
SAN FRANCISCO CA
94133-4685
US

V. Phone/Fax

Practice location:
  • Phone: 610-730-6229
  • Fax:
Mailing address:
  • Phone: 610-730-6229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMIR GHIA
Title or Position: GENERAL COUNSEL
Credential:
Phone: 610-730-6229