Healthcare Provider Details

I. General information

NPI: 1659733558
Provider Name (Legal Business Name): OPTIMA HOME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 ALAMO ST SUITE 200
SIMI VALLEY CA
93063-2188
US

IV. Provider business mailing address

3695 ALAMO ST SUITE 200
SIMI VALLEY CA
93063-2188
US

V. Phone/Fax

Practice location:
  • Phone: 805-212-7220
  • Fax:
Mailing address:
  • Phone: 805-212-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SCOTT M TISHERMAN
Title or Position: PRESIDENT
Credential:
Phone: 805-212-7220