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General NPI Number Information
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NPI Number | 1073320354
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Entity Type | Organization
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Legal Business Name | MEDICUS OPTIMUS MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 35410 DEL REY
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City | DANA POINT
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State | CA
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Zip | 92624-1814
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Country | US
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Telephone | 801-330-9242
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Fax |
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Provider Business Mailing Address
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Address Line | 1 HOAG DR
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4162
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Country | US
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Telephone | 801-330-9242
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NATHAN GILMORE
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Credential | MD
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Telephone | 801-330-9242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State |
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