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General NPI Number Information
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NPI Number | 1538157813
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Entity Type | Organization
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Legal Business Name | OPTIMUS MEDICAL, INC.
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 842 CALLE CAMPECHE SUITE 102
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City | PONCE
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State | PR
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Zip | 00717-1672
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Country | US
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Telephone | 787-984-0036
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Fax | 787-984-0036
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Provider Business Mailing Address
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Address Line | PO BOX 34412
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City | PONCE
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State | PR
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Zip | 00734-4412
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Country | US
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Telephone | 787-984-0036
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Fax | 787-984-0036
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORGE POZAS - NET
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Credential |
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Telephone | 787-984-0036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 005165
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License Number State | PR
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