Provider Demographics
NPI:1568847788
Name:ULTRA WELLNESS SERVICES INC
Entity Type:Organization
Organization Name:ULTRA WELLNESS SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOLEDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-924-8149
Mailing Address - Street 1:2460 SW 137TH AVE
Mailing Address - Street 2:STE 243
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-8803
Mailing Address - Country:US
Mailing Address - Phone:305-924-8149
Mailing Address - Fax:305-551-1121
Practice Address - Street 1:2460 SW 137TH AVE
Practice Address - Street 2:STE 243
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8803
Practice Address - Country:US
Practice Address - Phone:305-924-8149
Practice Address - Fax:305-551-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation