Healthcare Provider Details

I. General information

NPI: 1104737303
Provider Name (Legal Business Name): RAY CAMERON ULATAN VIALU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 LANGSDORF DR STE 200
FULLERTON CA
92831-3702
US

IV. Provider business mailing address

17311 JOSIE CIR
BELLFLOWER CA
90706-6771
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-9264
  • Fax: 714-871-5032
Mailing address:
  • Phone: 808-348-3552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: