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General NPI Number Information
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NPI Number | 1730114331
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Entity Type | Organization
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Legal Business Name | OPTIMUM MEDICAL CENTER INC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 7575 SW 62ND AVE SUITE B
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4955
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Country | US
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Telephone | 305-662-4005
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Fax | 305-557-9030
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Provider Business Mailing Address
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Address Line | 7575 SW 62ND AVE SUITE B
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4955
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Country | US
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Telephone | 305-662-4005
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Fax | 305-557-9030
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTONIO PIEDRA
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Credential |
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Telephone | 305-662-4005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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