NPIMap

Organization Active NPI

San Diego Optimum Compounding

  • Pharmacy
  • Poway, CA
National Provider Identifier
1386021780
Registry record updated Oct 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
53633 Issued in CA
Legal business name
SAN DIEGO OPTIMUM COMPOUNDING
Practice address
12265 Scripps Poway Pkwy
Suite 114
Poway, CA 92064-6151
Phone
(858) 699-6563
NPI assigned
May 5, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2015

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

Authorized official

Name
Dr. Maii El-Shatanoufy, RPH
Title
Ceo
Phone
(858) 699-6563

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 53633 CA Primary

Addresses

Primary practice location

12265 Scripps Poway Pkwy
Suite 114
Poway, CA 92064-6151

Mailing address

12265 Scripps Poway Pkwy
Suite 114
Poway, CA 92064-6151
Phone (858) 699-6563

National Provider Directory

National Provider Directory

Locations

12265 Scripps Poway Pkwy
Ste 114
Poway, CA 92064
Phone (858) 699-6563

NPI Registry JSON

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

{
    "created_epoch": "1430784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445904000000",
    "number": "1386021780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12265 SCRIPPS POWAY PKWY",
            "address_2": "SUITE 114",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920646151",
            "telephone_number": "858-699-6563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12265 SCRIPPS POWAY PKWY",
            "address_2": "SUITE 114",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920646151",
            "telephone_number": "858-699-6563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO OPTIMUM COMPOUNDING",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-05",
        "last_updated": "2015-10-27",
        "status": "A",
        "authorized_official_last_name": "EL-SHATANOUFY",
        "authorized_official_first_name": "MAII",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "858-699-6563",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "53633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poway, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2015; 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.