Healthcare Provider Details

I. General information

NPI: 1902134729
Provider Name (Legal Business Name): OPRIMUM DYNAMIC ACHIEVEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28364 VINCENT MORAGA SUITE C
TEMECULA CA
92590
US

IV. Provider business mailing address

28364 VINCENT MORAGA SUITE C
TEMECULA CA
92590
US

V. Phone/Fax

Practice location:
  • Phone: 951-699-3030
  • Fax:
Mailing address:
  • Phone: 951-699-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARIN D'ANN SARFATY
Title or Position: PRESIDENT
Credential:
Phone: 951-699-3030