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General NPI Number Information
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NPI Number | 1518683531
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Entity Type | Organization
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Legal Business Name | ULTAMED CORPORATION
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Dates
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Enumeration Date | 10/12/2022
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 2307 SEA ISLAND DR
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-1574
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Country | US
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Telephone | 949-468-9301
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Fax |
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Provider Business Mailing Address
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Address Line | 2307 SEA ISLAND DR
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-1574
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/ PRESIDENT
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Name | LAURA EATON-JANKOV
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Credential |
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Telephone | 949-468-9301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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