Provider Demographics
NPI:1003423468
Name:ULTIMATE PREVENTIVE CARE GROUP INC
Entity Type:Organization
Organization Name:ULTIMATE PREVENTIVE CARE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-326-0613
Mailing Address - Street 1:5632 NW 99TH WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2829
Mailing Address - Country:US
Mailing Address - Phone:954-326-0613
Mailing Address - Fax:
Practice Address - Street 1:5632 NW 99TH WAY
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2829
Practice Address - Country:US
Practice Address - Phone:954-326-0613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1669933974OtherNPI