Provider Demographics
NPI:1962053728
Name:OPTIMUM CARE MEDICAL GROUP
Entity type:Organization
Organization Name:OPTIMUM CARE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PENALVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-470-0024
Mailing Address - Street 1:10312 BLOOMINGDALE AVE
Mailing Address - Street 2:STE 108 PMB 339
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3603
Mailing Address - Country:US
Mailing Address - Phone:786-470-0024
Mailing Address - Fax:786-652-1372
Practice Address - Street 1:3908 SW 137TH AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-5712
Practice Address - Country:US
Practice Address - Phone:786-470-0024
Practice Address - Fax:954-806-2484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care