OPTUM INFUSION SERVICES 402, LLC (NPI# 1669602165) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669602165 |
| Entity Type | Organization |
| Organization Name | OPTUM INFUSION SERVICES 402, LLC |
| Practice Address |
2300 Main St Ste 150 Irvine CA 92614-6223 |
| Practice Telephone | 5622635600 |
| Practice Fax Number | 8664762489 |
| Mailing Telephone | 5622635600 |
| Mailing Fax Number | 8664762489 |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2020-03-09 |
| Authorized Official Name | EDWARD KRAMM (CEO) |
| Authorized Official Telephone | 8773429352 |
| Is Organization Subpart | Y |
| Parent Organization Name | SCP SPECIALTY INFUSION, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | PHY 51751 | CA | Suppliers |
| Y | 3336H0001X |
Pharmacy Specialization: Home Infusion Therapy Pharmacy |
PHY 51751 | CA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | STATE PHARMACY LICENSE | PHY57578 | 01 |
| Street Address |
2300 MAIN ST STE 150 |
| City | IRVINE |
| State | CA |
| Zip Code | 92614-6223 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396352944 | Irvine Surgical Center LLC | Clinic/Center | 17624 Redhill Ave Ste B, Irvine, CA 92614 | 2020-09-28 |
| 1245843572 | Jose Raul Sanchez IIi | Behavior Technician | 1063 Mcgraw Ave, Irvine, CA 92614 | 2020-08-26 |
| 1548871064 | Angelina Renee Armenta | Behavior Technician | 1063 Mcgraw Avenue, Suite 100, Irvine, CA 92614 | 2020-08-10 |
| 1083267827 | Jd Health LLC | Durable Medical Equipment & Medical Supplies | 18003 Sky Park Circle, Suite B-c, Irvine, CA 92614 | 2019-07-22 |
| 1326609280 | Abigail Briana Lozano-flores | Behavior Technician | 18008 Sky Park Circle, Suite 110, Irvine, CA 92614 | 2019-06-21 |
| 1770085235 | Heather M. Ayala | Dietitian, Registered | 17985 Sky Park Circle Suite A, Irvine, CA 92614 | 2018-03-01 |
| 1598266033 | Camille Plumbar | Chiropractor | 17811 Skypark Circle, Suite E, Irvine, CA 92614 | 2018-02-21 |
| 1952812448 | Mary M Ahmadian | Nurse Practitioner | Global Transitional Care Suite 100, 2 Executive Circle, Irvine, CA 92614 | 2017-10-24 |
| 1134656804 | Reza Abaei Tafreshi | Dentist | 3 Pazzi, Irvine, CA 92614 | 2017-05-12 |
| 1467991307 | Laboratory Medicine Consultants In Diagnostics | Medical Genetics | 1565 A Mcgaw Ave, Irvine, CA 92614 | 2017-02-13 |
| Find all providers in zip 92614 | ||||
| Taxonomy Code | 3336H0001X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Home Infusion Therapy Pharmacy |
| Pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients with acute or chronic conditions generally pertaining to parenteral administration of drugs, biologics and nutritional formulae administered through catheters and/or needles in home and alternate sites. Extensive professional pharmacy services, care coordination, infusion nursing services, supplies and equipment are provided to optimize efficacy and compliance. |
| Notes: Source: National Home Infusion Association [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447897921 | Pharmacy Home Infusion Network | Pharmacy | 900 W Glenoaks Blvd Ste G, Glendale, CA 91202-2664 | 2019-12-04 |
| 1073085007 | Kaiser Foundation Health Plan Inc | Pharmacy | 615 W Avenue L Trailer, Lancaster, CA 93534-7211 | 2019-01-02 |
| 1386155752 | Toci Health Inc | Pharmacy | 8851 Watson St Apt B, Cypress, CA 90630-2269 | 2017-10-12 |
| 1154875466 | Medquick Prescription Shoppe Inc | Pharmacy | 923 Cole Ave, Los Angeles, CA 90038-2610 | 2016-08-04 |
| 1841665973 | Biomed California, Inc | Pharmacy | 721 S Glasgow Ave., Suite C, Inglewood, CA 90301-3016 | 2015-12-01 |
| 1790158756 | Soleo Health Inc. | Pharmacy | 1324 W. Winton Ave, Hayward, CA 94545-1408 | 2015-11-12 |
| 1982013462 | Medrx Infusion Clinical Pharmacy, LLC | Pharmacy | 415 N Oak St, Inglewood, CA 90302-3314 | 2014-08-08 |
| 1669884722 | Dm Clinical Collaborations | Pharmacy | 6108 San Fernando Rd, Glendale, CA 91201-2240 | 2014-05-23 |
| 1609209352 | Santa Barbara Specialty Pharmacy LLC | Pharmacy | 4690 Carpinteria Ave Ste B, Carpinteria, CA 93013-1875 | 2013-08-16 |
| 1265773501 | Saint Paul Enterprises, Inc. | Pharmacy | 1010 E Arrow Hwy, Covina, CA 91724-1020 | 2013-03-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.