Organization Active NPI

Ultimate Medical Center & Spa LLC

  • General Practice Physician
  • Miami, FL
National Provider Identifier
1023663259
Registry record updated Aug 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
ULTIMATE MEDICAL CENTER & SPA LLC
Practice address
12700 SW 128TH St Ste 205
Miami, FL 33186-5378
Phone
(305) 278-7579
Fax
(305) 278-7589
NPI assigned
Aug 5, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Caridad Fonte Estevez
Title
Owner
Phone
(305) 278-7579

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

12700 SW 128TH St Ste 205
Miami, FL 33186-5378

Mailing address

12700 SW 128TH St Ste 205
Miami, FL 33186-5378
Phone (305) 278-7579

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191023000688 FL Part B Supplier - Clinic/Group Practice 0648502781 Receives reassigned benefits from 1 practitioner
Practice locations: Miami, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2172743Ultimate Medical Center & Spa, LLC12700 SW 128TH St Ste 205, Miami, FL 33186Certificate of waiverOct 9, 2026

National Provider Directory

National Provider Directory

Locations

12700 SW 128th St
Ste 205
Miami, FL 33186
Phone (305) 278-7579

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564963200000",
    "number": "1023663259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12700 SW 128TH ST STE 205",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331865378",
            "telephone_number": "305-278-7579",
            "fax_number": "305-278-7589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12700 SW 128TH ST STE 205",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331865378",
            "telephone_number": "305-278-7579",
            "fax_number": "305-278-7589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULTIMATE MEDICAL CENTER & SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-05",
        "last_updated": "2019-08-05",
        "status": "A",
        "authorized_official_last_name": "FONTE ESTEVEZ",
        "authorized_official_first_name": "CARIDAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-278-7579"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.