Provider Demographics
NPI:1477433571
Name:OPTIMUS HEALTH & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:OPTIMUS HEALTH & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LIUT
Authorized Official - Middle Name:IVON
Authorized Official - Last Name:DE LA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:813-270-5227
Mailing Address - Street 1:6802 W HILLSBOROUGH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5004
Mailing Address - Country:US
Mailing Address - Phone:813-270-5227
Mailing Address - Fax:
Practice Address - Street 1:6802 W HILLSBOROUGH AVE STE 4
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5004
Practice Address - Country:US
Practice Address - Phone:813-270-5227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty