Basic Information
| Provider Information | |||||||||
| NPI: | 1407500564 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | IDEAL OPPORTUNITIES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 GEORGE DIETER DR STE 636 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799365692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9156711371 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1605 GEORGE DIETER DR STE 636 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799365692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9156711371 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2022 | ||||||||
| LastUpdateDate: | 02/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | PETRUS | ||||||||
| AuthorizedOfficialFirstName: | PHILIPPE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9156711371 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PA | ||||||||
| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.