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General NPI Number Information
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NPI Number | 1003461096
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Entity Type | Organization
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Legal Business Name | OPTIMAL CARE MEDICAL GROUP
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Dates
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Enumeration Date | 08/06/2019
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 2675 E SLAUSON AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-2926
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Country | US
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Telephone | 323-749-6777
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Fax | 323-835-6035
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Provider Business Mailing Address
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Address Line | 2675 E SLAUSON AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-2926
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Country | US
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Telephone | 323-749-6777
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Fax | 323-835-6035
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Authorized Official
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Title or Position | CEO
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Name | PIERRE AUBERT ESPENAN
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Credential | MD
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Telephone | 323-749-6777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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