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General NPI Number Information
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NPI Number | 1225636855
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Entity Type | Organization
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Legal Business Name | OPTIMUM WELLNESS AND WEIGHT LOSS
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 910 S EL CAMINO REAL STE 100
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4279
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Country | US
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Telephone | 949-363-3162
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Fax | 888-408-8262
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Provider Business Mailing Address
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Address Line | 638 CAMINO DE LOS MARES # H130-103
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2848
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Country | US
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Telephone | 310-595-0679
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUNAO GILBERT
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Credential | MD, FAARFM
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Telephone | 949-363-3162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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