Provider Demographics
NPI:1114621265
Name:NULA MEDICAL MANAGEMENT II, LLC
Entity Type:Organization
Organization Name:NULA MEDICAL MANAGEMENT II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTERSOHN-MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-345-7350
Mailing Address - Street 1:4090 W WHITEWATER AVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-2403
Mailing Address - Country:US
Mailing Address - Phone:954-696-6232
Mailing Address - Fax:
Practice Address - Street 1:4090 W WHITEWATER AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33332-2403
Practice Address - Country:US
Practice Address - Phone:954-696-6232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty