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NPI Code Detail

MEDICARE: DR. ALINE NOELLE ULLOA NP

MEDICARE: DR. ALINE NOELLE ULLOA NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LC0200XCritical Care Medicine Nurse Practitioner1023292TX

General Provider Information

NPI Number : 1053922559
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALINE NOELLE ULLOA NP
Provider Business Mailing Address
First Line : 6004 AKIN SONG
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78261-2175
Country : US
Telephone Number : 253-310-6980
Fax Number :
Provider Business Practice Location Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : JBSA FT SAM HOUSTON
State : TX
Zip : 78234-4504
Country : US
Telephone Number : 210-916-2798
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2020
Last Update Date : 03/22/2021

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