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General NPI Number Information
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NPI Number | 1205712494
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Entity Type | Individual
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Provider Name | DANIEL ULLOA
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Gender | Male
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 6165 VALLEY SPRINGS PKWY STE E
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City | RIVERSIDE
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State | CA
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Zip | 92507-0955
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Country | US
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Telephone | 951-214-6585
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Fax | 951-214-6589
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Provider Business Mailing Address
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Address Line | 10 THUNDER RUN APT 22E
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City | IRVINE
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State | CA
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Zip | 92614-7027
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Country | US
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Telephone | 714-351-3351
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 112039
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License Number State | CA
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