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General NPI Number Information
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NPI Number | 1609383363
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Entity Type | Organization
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Legal Business Name | FIRST STEP OPTIMAL HEALTH CORPORATION
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Dates
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Enumeration Date | 01/03/2018
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Last Update Date | 01/03/2018
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Provider Practice Location Address
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Address Line | 17290 JASMINE ST STE 101
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City | VICTORVILLE
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State | CA
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Zip | 92395-8300
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Country | US
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Telephone | 760-951-2400
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Fax | 951-840-2088
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Provider Business Mailing Address
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Address Line | 17290 JASMINE ST STE 101
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City | VICTORVILLE
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State | CA
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Zip | 92395-8300
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Country | US
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Telephone | 760-951-2400
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Fax | 951-840-2088
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Authorized Official
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Title or Position | OFFICE MGR
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Name | CHARLES WAITS
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Credential |
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Telephone | 909-322-3124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A552070
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License Number State | CA
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