Healthcare Provider Details

I. General information

NPI: 1942163332
Provider Name (Legal Business Name): OPTIMA ACUPUNCTURE AND WELLBEING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61396 S HIGHWAY 97 STE 205
BEND OR
97702-2159
US

IV. Provider business mailing address

61396 S HIGHWAY 97 STE 205
BEND OR
97702-2159
US

V. Phone/Fax

Practice location:
  • Phone: 541-390-6055
  • Fax:
Mailing address:
  • Phone: 541-390-6055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JOEL AMEZCUA
Title or Position: OWNER
Credential: LAC
Phone: 541-390-6055