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General NPI Number Information
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NPI Number | 1417373101
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Entity Type | Organization
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Legal Business Name | OPTIMAL METABOLIC SOLUTIONS LLC
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Dates
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Enumeration Date | 03/05/2014
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 40165 MURRIETA HOT SPRINGS RD UNIT I
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City | MURRIETA
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State | CA
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Zip | 92563-6434
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Country | US
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Telephone | 951-461-1800
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Fax | 951-461-1800
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Provider Business Mailing Address
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Address Line | 40165 MURRIETA HOT SPRINGS RD UNIT I
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City | MURRIETA
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State | CA
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Zip | 92563-6434
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Country | US
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Telephone | 951-461-1800
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Fax | 951-667-3383
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER BANKER
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Credential |
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Telephone | 951-514-9277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 330123AP
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License Number State | CA
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