Healthcare Provider Details

I. General information

NPI: 1033910732
Provider Name (Legal Business Name): ULLOA OCULOPLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 AVE ORTEGON STE 304
GUAYNABO PR
00966-2520
US

IV. Provider business mailing address

107 AVE ORTEGON STE 304
GUAYNABO PR
00966-2520
US

V. Phone/Fax

Practice location:
  • Phone: 787-430-4119
  • Fax: 787-622-0005
Mailing address:
  • Phone: 787-430-4119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. JAN PAUL ULLOA PADILLA
Title or Position: OWNER
Credential: MD
Phone: 787-430-4119