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General NPI Number Information
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NPI Number | 1578429403
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Entity Type | Organization
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Legal Business Name | OPTIMALLIFE PRIMARY CARE
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 441 OLD FORGE RD UNIT 24
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City | WARWICK
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State | RI
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Zip | 02818
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Country | US
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Telephone | 401-542-4330
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Fax |
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Provider Business Mailing Address
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Address Line | 597 OAKLAWN AVE
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City | CRANSTON
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State | RI
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Zip | 02920-3829
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Country | US
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Telephone | 401-542-4330
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MOHAMMED MALIK KATTAN
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Credential | FNP-C
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Telephone | 401-542-4330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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