Healthcare Provider Details

I. General information

NPI: 1457785131
Provider Name (Legal Business Name): OPTIMAL HEALTH AND PREVENTION RESEARCH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11199 SORRENTO VALLEY RD SUITE 202
SAN DIEGO CA
92121-1334
US

IV. Provider business mailing address

11199 SORRENTO VALLEY RD SUITE 202
SAN DIEGO CA
92121-1334
US

V. Phone/Fax

Practice location:
  • Phone: 858-255-6155
  • Fax:
Mailing address:
  • Phone: 858-255-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: DR. PAULA NENN
Title or Position: SENIOR MEDICAL DIRECTOR
Credential: MD
Phone: 858-255-6155