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General NPI Number Information
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NPI Number | 1790563260
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Entity Type | Organization
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Legal Business Name | OPTIMAL BODY NURSING CENTER, INC.
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 23861 MCBEAN PKWY STE A4
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City | SANTA CLARITA
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State | CA
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Zip | 91355-2003
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Country | US
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Telephone | 661-388-0339
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Fax |
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Provider Business Mailing Address
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Address Line | 23861 MCBEAN PKWY STE A4
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City | SANTA CLARITA
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State | CA
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Zip | 91355-2003
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Country | US
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Telephone | 661-388-0339
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Fax |
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Authorized Official
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Title or Position | CEO/CO-OWNER
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Name | JENIFER REZENDE SULLIVAN
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Credential | FNP-C
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Telephone | 818-470-2848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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