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General NPI Number Information
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NPI Number | 1790955425
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Entity Type | Organization
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Legal Business Name | ULTIMATE HMD, LLC
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 6355 NW 36TH ST SUITE # 604
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-7027
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Country | US
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Telephone | 305-492-2233
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Fax | 305-492-2255
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Provider Business Mailing Address
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Address Line | 6355 NW 36TH ST SUITE # 604
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-7027
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Country | US
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Telephone | 305-492-2233
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Fax | 305-492-2255
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JORGE RECAREY
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Credential |
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Telephone | 305-492-2233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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