Provider Demographics
NPI:1063921294
Name:OPTIMAL HEALTH BY DR ANEELA
Entity type:Organization
Organization Name:OPTIMAL HEALTH BY DR ANEELA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-676-5824
Mailing Address - Street 1:2610 WHIPPET WAY
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5236
Mailing Address - Country:US
Mailing Address - Phone:240-676-5824
Mailing Address - Fax:928-554-1052
Practice Address - Street 1:2610 WHIPPET WAY
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5236
Practice Address - Country:US
Practice Address - Phone:240-676-5824
Practice Address - Fax:928-554-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ52508207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ145041OtherAHCCCS