Organization
OLD PUEBLO HEALTHCARE LLC
Active
Other names
OPTIMA MEDICAL
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL O'NEIL (CEO)
(480) 660-6706
Entity
Organization
Contact information
Practice address
5981 E GRANT RD, SUITE 115, TUCSON, AZ 85712
(520) 886-5315
(520) 298-8201
Mailing address
5981 E GRANT RD, SUITE 115, TUCSON, AZ 85712
(520) 886-5315
(520) 298-8201
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN069526
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101738
—
AZ
Enumeration date
05/20/2006
Last updated
06/15/2020
About Stedi
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