Provider Demographics
NPI:1285788083
Name:OPTIMUM REHAB, INC.
Entity type:Organization
Organization Name:OPTIMUM REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-323-6955
Mailing Address - Street 1:1061 S SUN DR STE 1089
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6169
Mailing Address - Country:US
Mailing Address - Phone:407-323-6955
Mailing Address - Fax:855-306-2974
Practice Address - Street 1:1061 S SUN DR STE 1089
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6169
Practice Address - Country:US
Practice Address - Phone:407-323-6955
Practice Address - Fax:855-306-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015720500Medicaid