# OPTIMUM HEALTH AND NUTRITION, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619390671
- **Authorized official:** RAQUEL LOPEZ RDN, LDN (PRESIDENT/ REGISTERED DIETITIAN)
- **Authorized official phone:** (708) 527-0772

## Contact information

- **Practice address:** 8805 S 82ND AVE, HICKORY HILLS, IL 60457-1444
- **Practice address phone:** (708) 527-0772
- **Mailing address:** 8805 S 82ND AVE, HICKORY HILLS, IL 60457-1444
- **Mailing address phone:** (708) 527-0772

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 164.005838 | IL | Yes |

## Other

- **Enumeration date:** 01/28/2014
- **Last updated:** 01/28/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0670 | CNA | IL |
| 01 | — | 1619308608 | MEDICARE NPI TYPE I LISTED BELOW | IL |
| 01 | — | 164.005838 | LICENSED DIETITIAN NUTRITIONIST LICENSE NUMBER | IL |