Healthcare Provider Details

I. General information

NPI: 1841677325
Provider Name (Legal Business Name): YULIANA ULLOA B.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 GUERNEVILLE RD SUITE 218
SANTA ROSA CA
95403-7220
US

IV. Provider business mailing address

1421 GUERNEVILLE RD SUITE 218
SANTA ROSA CA
95403-7220
US

V. Phone/Fax

Practice location:
  • Phone: 707-576-7700
  • Fax: 707-576-9700
Mailing address:
  • Phone: 707-576-7700
  • Fax: 707-576-9700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: