| Health Medical Ultra Limited Liability Company | |
|
1760 Havendale Blvd Nw Winter Haven FL 33881-1224 | |
| (863) 662-3007 | |
| (863) 875-4681 |
| Full Name | Health Medical Ultra Limited Liability Company |
|---|---|
| Speciality | Family Medicine |
| Location | 1760 Havendale Blvd Nw, Winter Haven, Florida |
| Authorized Official Name and Position | Maria I Diez (CREDENTIALING MANAGER) |
| Authorized Official Contact | 7863995995 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Health Medical Ultra Limited Liability Company 1760 Havendale Blvd Nw Winter Haven FL 33881-1224 Ph: (939) 235-8227 | Health Medical Ultra Limited Liability Company 1760 Havendale Blvd Nw Winter Haven FL 33881-1224 Ph: (863) 662-3007 |
| NPI Number | 1942829536 |
|---|---|
| Provider Enumeration Date | 04/13/2020 |
| Last Update Date | 09/18/2020 |
| Medicare PECOS PAC ID | 8022435320 |
|---|---|
| Medicare Enrollment ID | O20200901002750 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942829536 | NPI | - | NPPES |
| 100166000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| Provider Name | Juan L Caparros Gonzales |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1801991054 PECOS PAC ID: 3476646365 Enrollment ID: I20180323000183 |
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