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Organization
HEALTH MEDICAL ULTRA LIMITED LIABILITY COMPANY
Active
Organization
HEALTH MEDICAL ULTRA LIMITED LIABILITY COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA I DIEZ (CREDENTIALING MANAGER)
(786) 399-5995
Entity
Organization
Contact information
Practice address
2402 LAKE DR NW, WINTER HAVEN, FL 33881-5008
(863) 662-3007
(863) 875-4681
Mailing address
2402 LAKE DR NW, WINTER HAVEN, FL 33881-5008
(863) 662-3007
(863) 875-4681
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
NULL
207QA0505X
Adult Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100166000
—
FL
Enumeration date
04/13/2020
Last updated
05/28/2026
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