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NPI Code Detail

MEDICARE: JESUS ULLOA

MEDICARE: JESUS ULLOA
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
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1174219836
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESUS ULLOA
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 : 323-854-9226
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 : 323-854-9226
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2023
Last Update Date : 04/14/2023

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Directions to “ JESUS ULLOA ” Practice Location

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