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General NPI Number Information
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NPI Number | 1477433571
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Entity Type | Organization
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Legal Business Name | OPTIMUS HEALTH & WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 6802 W HILLSBOROUGH AVE STE 4
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City | TAMPA
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State | FL
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Zip | 33634-5004
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Country | US
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Telephone | 813-270-5227
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Fax |
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Provider Business Mailing Address
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Address Line | 6802 W HILLSBOROUGH AVE STE 4
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City | TAMPA
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State | FL
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Zip | 33634-5004
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Country | US
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Telephone | 813-270-5227
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | LIUT IVON DE LA ROSA
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Credential | APRN
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Telephone | 813-270-5227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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