Optimum Health Associates, Inv.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G35611 Issued in CA

Legal business name

OPTIMUM HEALTH ASSOCIATES, INV.

Doing business as

Optimum Wellness Medical Group

Practice address

1030 S Glendale Ave
Suite 503
Glendale, CA 91205-5612

Phone

(818) 547-5400

Fax

(818) 547-3380

NPI assigned

Dec 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Grayce Megan Shields, M.D.

Title

President

Phone

(818) 547-5400

Specialties & licenses 1

Addresses

Other names 1

• Optimum Wellness Medical Group Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196726400000",
    "number": "1053593731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 S GLENDALE AVE",
            "address_2": "SUITE 503",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912055612",
            "telephone_number": "818-547-5400",
            "fax_number": "818-547-3380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 S GLENDALE AVE",
            "address_2": "SUITE 503",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912055612",
            "telephone_number": "818-547-5400",
            "fax_number": "818-547-3380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUM HEALTH ASSOCIATES, INV.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2007-12-04",
        "status": "A",
        "authorized_official_last_name": "SHIELDS",
        "authorized_official_first_name": "GRAYCE",
        "authorized_official_middle_name": "MEGAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-547-5400",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G35611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optimum Wellness Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Glendale, CA
• Providers in Glendale, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.