| Ultimate Medical Practice A Professional Corporation | |
|
3654 Highland Ave Suite 15 Highland CA 92346-2614 | |
| (909) 864-1006 | |
| (909) 864-1625 |
| Full Name | Ultimate Medical Practice A Professional Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 3654 Highland Ave, Highland, California |
| Authorized Official Name and Position | Richard Kangah (MEDICAL DIRECTOR/PRESIDENT) |
| Authorized Official Contact | 9098641006 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ultimate Medical Practice A Professional Corporation 3654 Highland Ave Suite 15 Highland CA 92346-2614 Ph: (909) 864-1006 | Ultimate Medical Practice A Professional Corporation 3654 Highland Ave Suite 15 Highland CA 92346-2614 Ph: (909) 864-1006 |
| NPI Number | 1962659573 |
|---|---|
| Provider Enumeration Date | 08/26/2008 |
| Last Update Date | 03/04/2009 |
| Medicare PECOS PAC ID | 0244393619 |
|---|---|
| Medicare Enrollment ID | O20090112000131 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962659573 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A55122 (California) | Primary |
| Provider Name | Richard Kangah |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1255379681 PECOS PAC ID: 5193809911 Enrollment ID: I20090318000469 |
| Provider Name | Beatrice Okoreeh-kangah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457520074 PECOS PAC ID: 1658438650 Enrollment ID: I20090415000000 |
| Provider Name | Priscilla Naamomo Otubuah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437551561 PECOS PAC ID: 7911277876 Enrollment ID: I20170725004065 |
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