Healthcare Provider Details

I. General information

NPI: 1396260063
Provider Name (Legal Business Name): ULTIMATE HEALTH MEDICAL SERVICES LLC., A CALIFORNIA LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 07/21/2022
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 PACIFIC AVE STE D
LONG BEACH CA
90806-1468
US

IV. Provider business mailing address

2800 PACIFIC AVE STE D
LONG BEACH CA
90806-1468
US

V. Phone/Fax

Practice location:
  • Phone: 562-337-8401
  • Fax: 562-337-8404
Mailing address:
  • Phone: 562-337-8401
  • Fax: 562-337-8404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0001X
TaxonomyClinical & Laboratory Immunology (Internal Medicine) Physician
License NumberA60718
License Number StateCA

VIII. Authorized Official

Name: MRS. BERTHA ALICIA ROSAS
Title or Position: OFFICE MANAGER
Credential:
Phone: 562-337-8401