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General NPI Number Information
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NPI Number | 1962849984
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Entity Type | Organization
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Legal Business Name | OPTIMIZE MEDICAL GROUP, INC
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Dates
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Enumeration Date | 05/31/2013
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 11110 OHIO AVE 108
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City | LOS ANGELES
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State | CA
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Zip | 90025-3388
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Country | US
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Telephone | 310-614-2024
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Fax | 310-473-5077
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Provider Business Mailing Address
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Address Line | 11110 OHIO AVE SUITE 108
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City | LOS ANGELES
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State | CA
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Zip | 90025-3388
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Country | US
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Telephone | 310-614-2024
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Fax | 310-473-5077
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Authorized Official
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Title or Position | DIRECTOR/VICE PRESIDENT
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Name | DR. ROBERTO CONTRERAS II
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Credential | M.D.
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Telephone | 310-614-2024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A108091
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License Number State | CA
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