NPIMap

Organization Active NPI

Optimum Medical Supply Corporation

  • Durable Medical Equipment & Medical Supplies
  • San Diego, CA
National Provider Identifier
1720650476
Registry record updated Jul 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
OPTIMUM MEDICAL SUPPLY CORPORATION
Practice address
3200 4TH Ave Ste 200
San Diego, CA 92103-5716
Phone
(858) 283-2391
NPI assigned
Jul 13, 2021
Last updated
Jul 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2022

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

Authorized official

Name
Jeanett Valenzuela Ayub
Title
Owner
Phone
(858) 283-2391

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

3200 4TH Ave Ste 200
San Diego, CA 92103-5716

Mailing address

964 5TH Ave Ste 408
San Diego, CA 92101-6102
Phone (858) 283-2391

National Provider Directory

National Provider Directory

Locations

3200 4th Ave
Ste 200
San Diego, CA 92103
Phone (858) 283-2391

964 5th Ave
Ste 408
San Diego, CA 92101

Practitioners & affiliated clinicians

Practitioners 81

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 81

NPI Registry JSON

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

{
    "created_epoch": "1626134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657152000000",
    "number": "1720650476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "964 5TH AVE STE 408",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921016102",
            "telephone_number": "858-283-2391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 4TH AVE STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921035716",
            "telephone_number": "858-283-2391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUM MEDICAL SUPPLY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-13",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A",
        "authorized_official_last_name": "VALENZUELA AYUB",
        "authorized_official_first_name": "JEANETT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "858-283-2391"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; 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.