Provider Demographics
NPI:1174219836
Name:ULLOA, JESUS
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:ULLOA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 N NORTH COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-3413
Mailing Address - Country:US
Mailing Address - Phone:323-854-9226
Mailing Address - Fax:
Practice Address - Street 1:3011 N NORTH COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-3413
Practice Address - Country:US
Practice Address - Phone:323-854-9226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant