Healthcare Provider Details

I. General information

NPI: 1114055654
Provider Name (Legal Business Name): DAVID STUART ULLMAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5727 CANOGA AVE # 291
WOODLAND HILLS CA
91367-6518
US

IV. Provider business mailing address

5727 CANOGA AVE # 291
WOODLAND HILLS CA
91367-6518
US

V. Phone/Fax

Practice location:
  • Phone: 818-992-5981
  • Fax: 818-992-5967
Mailing address:
  • Phone: 818-992-5981
  • Fax: 818-992-5967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE3227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: