Provider Demographics
NPI:1902127079
Name:OPTIMA INDUSTRIAL MEDICAL
Entity Type:Organization
Organization Name:OPTIMA INDUSTRIAL MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-632-5795
Mailing Address - Street 1:20401 SOUTH AVALON BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746
Mailing Address - Country:US
Mailing Address - Phone:310-632-5795
Mailing Address - Fax:310-632-5842
Practice Address - Street 1:20401 SOUTH AVALON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746
Practice Address - Country:US
Practice Address - Phone:310-632-5795
Practice Address - Fax:310-632-5842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57531146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Multi-Specialty