Organization
ULTIMATE WELLNESS PROVIDERS CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LASONJA MALONE CCMA (FOUNDER/ CEO)
(877) 768-4897
Entity
Organization
Contact information
Practice address
4914 BISSONNET ST STE 101, BELLAIRE, TX 77401-4047
(877) 768-4897
(832) 213-3075
Mailing address
4914 BISSONNET ST STE 101, BELLAIRE, TX 77401-4047
(877) 768-4897
(832) 213-3075
Taxonomy
Speciality
Code
Description
License number
State
202C00000X
Independent Medical Examiner Physician
—
—
251F00000X
Home Infusion Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QC1800X
Corporate Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Enumeration date
10/11/2021
Last updated
10/11/2021
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