Organization
BODYBY ULTIMATE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HYDER MUKADAM SR. M.D. (MEDICAL DIRECTOR)
(562) 336-1511
Entity
Organization
Contact information
Practice address
2777 PACIFIC AVE SUITE I, LONG BEACH, CA 90806
(562) 336-1511
(562) 336-1510
Mailing address
2777 PACIFIC AVE SUITE I, LONG BEACH, CA 90806
(562) 336-1511
(562) 336-1510
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
08/20/2024
Last updated
08/20/2024
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