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General NPI Number Information
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NPI Number | 1023484177
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Entity Type | Organization
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Legal Business Name | OPTUM MEDICAL SERVICES OF CALIFORNIA, PC
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 351 W CAMDEN ST SUITE 100
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City | BALTIMORE
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State | MD
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Zip | 21201-7912
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Country | US
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Telephone | 410-625-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 351 W CAMDEN ST SUITE 100
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City | BALTIMORE
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State | MD
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Zip | 21201-7912
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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 | DIRECTOR
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Name | RONALD SHUMACHER
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Credential | MD
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Telephone | 240-683-5331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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