Provider Demographics
NPI:1467645077
Name:SALUD OPTIMA MEDICAL CLINIC
Entity type:Organization
Organization Name:SALUD OPTIMA MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:IZVERNARI
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:951-306-9888
Mailing Address - Street 1:1031 E LATHAM AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4425
Mailing Address - Country:US
Mailing Address - Phone:951-306-9888
Mailing Address - Fax:
Practice Address - Street 1:1031 E LATHAM AVE STE 1
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4425
Practice Address - Country:US
Practice Address - Phone:951-306-9888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG554810261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center