MEDICARE: MIGUEL ANGEL JIMENEZ ULLOA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A113026	CA

General Provider Information

NPI Number	:	1497064794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL ANGEL JIMENEZ ULLOA M.D.

Provider Business Mailing Address
First Line	:	1737 W ROMNEYA DR
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-1804
Country	:	US
Telephone Number	:	714-631-4766
Fax Number	:

Provider Business Practice Location Address
First Line	:	1737 W ROMNEYA DR
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-1804
Country	:	US
Telephone Number	:	714-631-4766
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	12/30/2011

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