Provider Demographics
NPI:1427532316
Name:OPTIMAL HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:OPTIMAL HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOJIBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-PMH
Authorized Official - Phone:443-939-6585
Mailing Address - Street 1:1324 DEANWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-6004
Mailing Address - Country:US
Mailing Address - Phone:443-939-6585
Mailing Address - Fax:
Practice Address - Street 1:120 SISTER PIERRE DR STE 207
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7525
Practice Address - Country:US
Practice Address - Phone:443-939-6585
Practice Address - Fax:443-841-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty