MEDICARE: MEDICUS OPTIMUS MEDICAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician

General Provider Information

NPI Number	:	1073320354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICUS OPTIMUS MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	1 HOAG DR
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4162
Country	:	US
Telephone Number	:	801-330-9242
Fax Number	:

Provider Business Practice Location Address
First Line	:	35410 DEL REY
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92624-1814
Country	:	US
Telephone Number	:	801-330-9242
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NATHAN GILMORE
Credential	:	MD
Telephone Number	:	801-330-9242

Provider Enumeration Date	:	12/11/2024
Last Update Date	:	12/11/2024

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