Healthcare Provider Details

I. General information

NPI: 1013835362
Provider Name (Legal Business Name): LESLIE CAROLINA ULLOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 PARKCENTER DR STE 115
SANTA ANA CA
92705-3521
US

IV. Provider business mailing address

12532 CAY ST
TUSTIN CA
92780-2806
US

V. Phone/Fax

Practice location:
  • Phone: 714-310-4377
  • Fax:
Mailing address:
  • Phone: 657-363-2454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: