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General NPI Number Information
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NPI Number | 1659066785
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Entity Type | Organization
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Legal Business Name | OPTIMAL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 7206 N MILBURN AVE # 106
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City | FRESNO
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State | CA
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Zip | 93722-8450
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Country | US
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Telephone | 559-840-0066
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Fax | 559-272-0479
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Provider Business Mailing Address
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Address Line | 7206 N MILBURN AVE # 106
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City | FRESNO
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State | CA
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Zip | 93722-8450
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Country | US
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Telephone | 559-840-0066
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Fax | 559-272-0479
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KELLI VINUELA
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Credential |
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Telephone | 559-908-8158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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