Healthcare Provider Details

I. General information

NPI: 1295523314
Provider Name (Legal Business Name): OPTIMUM HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 SW WESTGATE DR STE 101
PORTLAND OR
97221-2424
US

IV. Provider business mailing address

5201 SW WESTGATE DR STE 101
PORTLAND OR
97221-2424
US

V. Phone/Fax

Practice location:
  • Phone: 503-688-0046
  • Fax: 503-961-8240
Mailing address:
  • Phone: 503-688-0046
  • Fax: 503-961-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PHILIP BOAMAH
Title or Position: DIRECTOR
Credential: ND
Phone: 503-688-0046