MEDICARE: JACQUELINE 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
1	104100000X	Social Worker
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1639969553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE ULLOA

Provider Business Mailing Address
First Line	:	58 4TH ST
Second Line	:
City	:	PASSAIC
State	:	NJ
Zip	:	07055-7405
Country	:	US
Telephone Number	:	973-405-8859
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 4TH ST
Second Line	:
City	:	PASSAIC
State	:	NJ
Zip	:	07055-7405
Country	:	US
Telephone Number	:	973-405-8859
Fax Number	:

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

Provider Enumeration Date	:	05/12/2025
Last Update Date	:	05/12/2025

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Directions to “ JACQUELINE ULLOA ” Practice Location

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