Healthcare Provider Details

I. General information

NPI: 1003423468
Provider Name (Legal Business Name): ULTIMATE PREVENTIVE CARE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5632 NW 99TH WAY
CORAL SPRINGS FL
33076-2829
US

IV. Provider business mailing address

5632 NW 99TH WAY
CORAL SPRINGS FL
33076-2829
US

V. Phone/Fax

Practice location:
  • Phone: 954-326-0613
  • Fax:
Mailing address:
  • Phone: 954-326-0613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE PEREZ
Title or Position: CEO
Credential: APRN
Phone: 954-326-0613