Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Optimum Care Provider, Inc

Organization Physical Therapist · NPI 1114211885

Optimum Care Provider, Inc is a Physical Therapist in Victorville, California. Licensed in California. Registered with an NPI since 2011.

Licensed in
CA
In the registry since
2011
Specialties on file
3
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

12381 Bali St
Victorville, CA 92392-6825
Phone: (909) 509-6064
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 33402 (CA)
Occupational Therapist Taxonomy 225X00000X
Speech-Language Pathologist Taxonomy 235Z00000X

Record details

NPI number1114211885
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Eleazar Tayag — Ceo · (909) 509-6064
NPI enumeratedMay 31, 2011
Last updated in NPPESOctober 15, 2023
Certification dateOctober 15, 2023
Mailing address15260 Anacapa Rd Ste A12, Victorville, CA 92392-2565

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