Provider Demographics
NPI:1700371101
Name:CHIROSAMURAI
Entity Type:Organization
Organization Name:CHIROSAMURAI
Other - Org Name:ULTIMATE HEALTH AND FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VENTURA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELUZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-747-8500
Mailing Address - Street 1:A31 ENEAS
Mailing Address - Street 2:VENUS GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-674-8440
Mailing Address - Fax:
Practice Address - Street 1:CARR 1 KM 30.6 BO GUASABARA
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-747-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0371261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center