Provider Demographics
NPI:1083420517
Name:OPTIMAL LIFESTYLE MEDICINE PLLC
Entity type:Organization
Organization Name:OPTIMAL LIFESTYLE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:PERALES
Authorized Official - Suffix:JR
Authorized Official - Credentials:NP
Authorized Official - Phone:956-483-9942
Mailing Address - Street 1:520 E DOVE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2241
Mailing Address - Country:US
Mailing Address - Phone:956-905-0102
Mailing Address - Fax:956-658-7152
Practice Address - Street 1:520 E DOVE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2241
Practice Address - Country:US
Practice Address - Phone:956-905-0102
Practice Address - Fax:956-658-7152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty