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Organization
OPTIMUM CARE PROVIDER, INC.
Active
Organization
OPTIMUM CARE PROVIDER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELEAZAR SOMINTAC TAYAG PT (CEO)
(909) 509-6064
Entity
Organization
Contact information
Practice address
12381 BALI ST, VICTORVILLE, CA 92392-6825
(909) 509-6064
Mailing address
15260 ANACAPA RD STE A12, VICTORVILLE, CA 92392-2565
(909) 509-6064
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
33402
CA
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
05/31/2011
Last updated
10/15/2023
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