Provider Demographics
NPI:1396260063
Name:ULTIMATE HEALTH MEDICAL SERVICES LLC., A CALIFORNIA LIABILITY COMPANY
Entity type:Organization
Organization Name:ULTIMATE HEALTH MEDICAL SERVICES LLC., A CALIFORNIA LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:ROSAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-337-8401
Mailing Address - Street 1:2800 PACIFIC AVE STE D
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1468
Mailing Address - Country:US
Mailing Address - Phone:562-337-8401
Mailing Address - Fax:562-337-8404
Practice Address - Street 1:2800 PACIFIC AVE STE D
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1468
Practice Address - Country:US
Practice Address - Phone:562-337-8401
Practice Address - Fax:562-337-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60718207RI0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA193200000XMedicaid