Healthcare Provider Details

I. General information

NPI: 1609975010
Provider Name (Legal Business Name): OPTIMA INFUSION PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 26.2 ESPINOSA WARD
DORADO PR
00646
US

IV. Provider business mailing address

HC 3 BOX 7525
DORADO PR
00646-9539
US

V. Phone/Fax

Practice location:
  • Phone: 787-883-5959
  • Fax: 787-883-6042
Mailing address:
  • Phone: 787-883-5959
  • Fax: 787-883-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number07F2314
License Number StatePR

VIII. Authorized Official

Name: MARIELY DIAZ
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 787-883-5959