| NPI | 1336624113 |
|---|---|
| Former Legal Business Name | OPTIMUM FAMILY CLINIC LLC |
| Entity Type | Organization |
| Authorized Contact | BLESSING GABRIEL Provider 703-436-1823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2018-09-27 |
| Last Update Date | 2019-09-26 |