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General NPI Number Information
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NPI Number | 1023339165
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Entity Type | Organization
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Legal Business Name | OPTUMCARE MANAGEMENT, LLC
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 08/19/2019
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Provider Practice Location Address
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Address Line | 5001 LAKEWOOD BLVD
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City | LAKEWOOD
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State | CA
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Zip | 90712-2412
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Country | US
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Telephone | 562-361-5650
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 6400
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City | TORRANCE
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State | CA
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Zip | 90504-6400
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | JOHN G. LIETHEN
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Credential |
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Telephone | 952-205-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | C38824
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License Number State | CA
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