Provider Demographics
NPI:1053593731
Name:OPTIMUM HEALTH ASSOCIATES, INV.
Entity type:Organization
Organization Name:OPTIMUM HEALTH ASSOCIATES, INV.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRAYCE
Authorized Official - Middle Name:MEGAN
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-547-5400
Mailing Address - Street 1:1030 S GLENDALE AVE
Mailing Address - Street 2:SUITE 503
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-5612
Mailing Address - Country:US
Mailing Address - Phone:818-547-5400
Mailing Address - Fax:818-547-3380
Practice Address - Street 1:1030 S GLENDALE AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-5612
Practice Address - Country:US
Practice Address - Phone:818-547-5400
Practice Address - Fax:818-547-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35611207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty