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General NPI Number Information
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NPI Number | 1972221075
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Entity Type | Organization
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Legal Business Name | OPTIMA SPINE AND JOINT, INC
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Dates
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Enumeration Date | 08/16/2022
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 7100 W 21 AVE STE# 501
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City | HIALEAH
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State | FL
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Zip | 33016
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Country | US
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Telephone | 305-900-4357
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Fax |
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Provider Business Mailing Address
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Address Line | 201 N KROME AVE STE 210
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City | HOMESTEAD
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State | FL
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Zip | 33030-6011
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Country | US
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Telephone | 305-900-4357
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | REYNALDO PEREZ
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Credential |
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Telephone | 305-610-2012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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