MEDICARE: THE ULTIMATE EXPERIENCE HEALTH AND WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1063158152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ULTIMATE EXPERIENCE HEALTH AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	4730 OAKLAND ST STE 300
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80239-2731
Country	:	US
Telephone Number	:	720-982-3887
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 OAKLAND ST STE 300
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80239-2731
Country	:	US
Telephone Number	:	720-982-3887
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEISHA DELEON-PARIS
Credential	:	NP
Telephone Number	:	720-982-3887

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	01/26/2023

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