1053701698 NPI number — UNLIMITED PROFESSIONAL GROUP INC

Table of content: (NPI 1053701698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053701698 NPI number — UNLIMITED PROFESSIONAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNLIMITED PROFESSIONAL GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053701698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7969 NW 2ND ST
Provider Second Line Business Mailing Address:
SUITE# 252
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33126-8018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-366-0531
Provider Business Mailing Address Fax Number:
786-504-9676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7969 NW 2ND ST
Provider Second Line Business Practice Location Address:
SUITE# 252
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-8018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-366-0531
Provider Business Practice Location Address Fax Number:
786-504-9676
Provider Enumeration Date:
02/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
VALDEZ
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
LUIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
786-366-0531

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  ME58033 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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