MEDICARE: MS. LUCIA ULLAURI

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	172V00000X	Community Health Worker	0441	OR

General Provider Information

NPI Number	:	1942768700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LUCIA ULLAURI

Provider Business Mailing Address
First Line	:	7110 SW FIR LOOP
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-8084
Country	:	US
Telephone Number	:	971-283-1120
Fax Number	:

Provider Business Practice Location Address
First Line	:	7110 SW FIR LOOP
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-8084
Country	:	US
Telephone Number	:	971-283-1120
Fax Number	:

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

Provider Enumeration Date	:	03/11/2019
Last Update Date	:	03/11/2019

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