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General NPI Number Information
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NPI Number | 1326231747
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Entity Type | Organization
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Legal Business Name | LUIS S. ULLOA MDPA
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 3370 BURNS RD SUITE#105
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4327
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Country | US
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Telephone | 561-627-7766
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Fax | 561-691-4865
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Provider Business Mailing Address
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Address Line | 601 UNIVERSITY BLVD SIUTE #202
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City | JUPITER
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State | FL
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Zip | 33458-2788
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Country | US
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Telephone | 561-627-7766
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Fax | 561-691-4865
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS S ULLOA
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Credential | M.D.
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Telephone | 561-627-7766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0038283
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License Number State | FL
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