Provider Demographics
NPI:1063158152
Name:THE ULTIMATE EXPERIENCE HEALTH AND WELLNESS CENTER
Entity type:Organization
Organization Name:THE ULTIMATE EXPERIENCE HEALTH AND WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEON-PARIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:720-982-3887
Mailing Address - Street 1:4730 OAKLAND ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-2731
Mailing Address - Country:US
Mailing Address - Phone:720-982-3887
Mailing Address - Fax:
Practice Address - Street 1:4730 OAKLAND ST STE 300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-2731
Practice Address - Country:US
Practice Address - Phone:720-982-3887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE ULTIMATE EXPERIENCE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-11
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty