Healthcare Provider Details

I. General information

NPI: 1891221040
Provider Name (Legal Business Name): ULTIMATE HEALTH & FITNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 1 KM 30.6 BO GUASABARA
CAGUAS PR
00726
US

IV. Provider business mailing address

344 LOMAS DE LA SERRANIA TULIPAN
CAGUAS PR
00726
US

V. Phone/Fax

Practice location:
  • Phone: 787-747-8500
  • Fax:
Mailing address:
  • Phone: 787-525-5529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. PRISCILLA MARIE FERNANDEZ
Title or Position: PRESIDENT
Credential: ND
Phone: 787-525-5529