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General NPI Number Information
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NPI Number | 1699012435
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Entity Type | Organization
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Legal Business Name | OPTIMA WEIGHT & WELLNESS, LLC
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Dates
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Enumeration Date | 01/14/2013
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 1489 E 15TH ST SUITE 108
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City | EDMOND
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State | OK
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Zip | 73013-5054
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Country | US
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Telephone | 405-715-1919
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Fax | 405-212-5043
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Provider Business Mailing Address
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Address Line | 1489 E 15TH ST SUITE 108
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City | EDMOND
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State | OK
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Zip | 73013-5054
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Country | US
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Telephone | 405-715-1919
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Fax | 405-212-5043
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Authorized Official
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Title or Position | BUSINESS/HR MANAGER
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Name | JENNIFER GONZALES
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Credential |
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Telephone | 405-429-5148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | OK
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