Dr. Fernando Ulloa
Adolescent Medicine
711 D St Suite 113
San Rafael
, California 94901-3707
Dr. Fernando Ulloa
Adolescent Medicine
711 D St Suite 113
San Rafael
, California 94901-3707
(415) 454-4100
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About
Features
Specialties
- Adolescent Medicine
Languages spoken
- English
Location
First Address
- Dr. Fernando Ulloa
- Po Box 1938
- Mill Valley, CA
- Zip : 94942-1938
- Phone : (415) 454-4100
Second Address
- Dr. Fernando Ulloa
- 711 D St Suite 113
- San Rafael, CA
- Zip : 94901-3707
- Phone : (415) 454-4100
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2080A0000X | Adolescent Medicine | G49903 | CA |
National Provider Identifier
| NPI | 1124140686 |
|---|---|
| Provider Name | Dr. Fernando Ulloa |
| First Address | Mill Valley, CA 94942-1938 |
| Second Address | San Rafael, CA 94901-3707 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 04/04/2007 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 00G49903 | (05) | CA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.