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NPI Code Detail

MEDICARE: LISSETTE ULLOA PMHNP

MEDICARE: LISSETTE ULLOA PMHNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner95037841CA

General Provider Information

NPI Number : 1154277655
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISSETTE ULLOA PMHNP
Provider Business Mailing Address
First Line : 3011 N NORTH COOLIDGE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90039-3413
Country : US
Telephone Number : 323-855-0928
Fax Number :
Provider Business Practice Location Address
First Line : 3011 N NORTH COOLIDGE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90039-3413
Country : US
Telephone Number : 323-855-0928
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2026
Last Update Date : 03/06/2026

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Directions to “ LISSETTE ULLOA PMHNP” Practice Location

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