Healthcare Provider Details

I. General information

NPI: 1023663259
Provider Name (Legal Business Name): ULTIMATE MEDICAL CENTER & SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 SW 128TH ST STE 205
MIAMI FL
33186-5378
US

IV. Provider business mailing address

12700 SW 128TH ST STE 205
MIAMI FL
33186-5378
US

V. Phone/Fax

Practice location:
  • Phone: 305-278-7579
  • Fax: 305-278-7589
Mailing address:
  • Phone: 305-278-7579
  • Fax: 305-278-7589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CARIDAD FONTE ESTEVEZ
Title or Position: OWNER
Credential:
Phone: 305-278-7579