MEDICARE: LUIS S ULLOA M.D.

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
1	207R00000X	Internal Medicine Physician	ME38283	FL

General Provider Information

NPI Number	:	1457318636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS S ULLOA M.D.

Provider Business Mailing Address
First Line	:	1094 MILITARY TRL
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7021
Country	:	US
Telephone Number	:	561-622-6111
Fax Number	:	855-215-9930

Provider Business Practice Location Address
First Line	:	601 UNIVERSITY BLVD
Second Line	:	SUITE 202
City	:	JUPITER
State	:	FL
Zip	:	33458-2788
Country	:	US
Telephone Number	:	561-627-7766
Fax Number	:	561-691-4865

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2006
Last Update Date	:	08/21/2020

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