| NPI | 1053593731 |
|---|---|
| Doing Business As | OPTIMUM WELLNESS MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | GRAYCE MEGAN SHIELDS President 818-547-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G35611) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2007-12-04 |