Healthcare Provider Details

I. General information

NPI: 1336071190
Provider Name (Legal Business Name): BLAKE ULVELING RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 ACTON ST
BERKELEY CA
94702-2111
US

IV. Provider business mailing address

2505 ACTON ST
BERKELEY CA
94702-2111
US

V. Phone/Fax

Practice location:
  • Phone: 510-387-2842
  • Fax:
Mailing address:
  • Phone: 510-387-2842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number802247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: