Healthcare Provider Details

I. General information

NPI: 1578429403
Provider Name (Legal Business Name): OPTIMALLIFE PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 OLD FORGE RD UNIT 24
WARWICK RI
02818
US

IV. Provider business mailing address

597 OAKLAWN AVE
CRANSTON RI
02920-3829
US

V. Phone/Fax

Practice location:
  • Phone: 401-542-4330
  • Fax:
Mailing address:
  • Phone: 401-542-4330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED MALIK KATTAN
Title or Position: MANAGING MEMBER
Credential: FNP-C
Phone: 401-542-4330