Basic Information
| Provider Information | |||||||||
| NPI: | 1780098525 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPTUMCARE MANAGEMENT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 6400 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905046400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103544221 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19191 S VERMONT AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905021018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103544221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2014 | ||||||||
| LastUpdateDate: | 08/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | LIETHEN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 9522056262 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.