Healthcare Provider Details

I. General information

NPI: 1568535730
Provider Name (Legal Business Name): ELIZABETH ULLOA LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH CARL LMP

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N NORTHGATE WAY
SEATTLE WA
98133-8913
US

IV. Provider business mailing address

1111 N NORTHGATE WAY
SEATTLE WA
98133-8913
US

V. Phone/Fax

Practice location:
  • Phone: 206-523-2225
  • Fax: 206-523-9101
Mailing address:
  • Phone: 206-523-2225
  • Fax: 206-523-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00016797
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: