| Ultra Medical Llc | |
|
10350 Pines Blvd Ste D103 Pembroke Pines FL 33026-6051 | |
| (754) 210-2460 | |
| Not Available |
| Full Name | Ultra Medical Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10350 Pines Blvd Ste D103, Pembroke Pines, Florida |
| Authorized Official Name and Position | Alfredo Infante (VP OPERATIONS) |
| Authorized Official Contact | 7542102460 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ultra Medical Llc 10350 Pines Blvd Ste D103 Pembroke Pines FL 33026-6051 Ph: (754) 210-2460 | Ultra Medical Llc 10350 Pines Blvd Ste D103 Pembroke Pines FL 33026-6051 Ph: (754) 210-2460 |
| NPI Number | 1972133163 |
|---|---|
| Provider Enumeration Date | 01/16/2020 |
| Last Update Date | 01/16/2020 |
| Medicare PECOS PAC ID | 1254741135 |
|---|---|
| Medicare Enrollment ID | O20201104000847 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972133163 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Angel R Mesa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477761898 PECOS PAC ID: 1254426604 Enrollment ID: I20071001000589 |
| Provider Name | Maria C Fernandez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1447489281 PECOS PAC ID: 4789721895 Enrollment ID: I20091022000224 |
| Provider Name | Joseph Je Vincent |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568876191 PECOS PAC ID: 2264754076 Enrollment ID: I20141205001782 |
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