Provider Demographics
NPI:1699457176
Name:OPTIMAL CARE AND WELLNESS LLC
Entity type:Organization
Organization Name:OPTIMAL CARE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:YESENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANAROS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:928-257-1223
Mailing Address - Street 1:74 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-2250
Mailing Address - Country:US
Mailing Address - Phone:928-287-0033
Mailing Address - Fax:
Practice Address - Street 1:74 W 2ND ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2250
Practice Address - Country:US
Practice Address - Phone:928-257-1223
Practice Address - Fax:928-267-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty