Provider Demographics
NPI:1538772488
Name:OPTIMUM KIDS LTD
Entity type:Organization
Organization Name:OPTIMUM KIDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSYCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-600-7921
Mailing Address - Street 1:1240 E BUSINESS 83 STE A
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-9600
Mailing Address - Country:US
Mailing Address - Phone:956-600-7921
Mailing Address - Fax:956-600-7923
Practice Address - Street 1:1240 E BUSINESS 83 STE A
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-9600
Practice Address - Country:US
Practice Address - Phone:956-600-7921
Practice Address - Fax:956-600-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation