Provider Demographics
NPI:1184656431
Name:ULTIMATE CARE CLINIC INC
Entity Type:Organization
Organization Name:ULTIMATE CARE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTOLONGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-444-4100
Mailing Address - Street 1:3990 W FLAGLER ST
Mailing Address - Street 2:SUITE #403
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1644
Mailing Address - Country:US
Mailing Address - Phone:305-444-4100
Mailing Address - Fax:305-444-4143
Practice Address - Street 1:3990 W FLAGLER ST
Practice Address - Street 2:SUITE #403
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33134-1644
Practice Address - Country:US
Practice Address - Phone:305-444-4100
Practice Address - Fax:305-444-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8241Medicare ID - Type Unspecified