Provider Demographics
NPI:1053670034
Name:ULLOA-JIMENEZ, LILIANA (DC)
Entity Type:Individual
Prefix:DR
First Name:LILIANA
Middle Name:
Last Name:ULLOA-JIMENEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LILIANA
Other - Middle Name:
Other - Last Name:ULLOA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2410 FAIR OAKS BLVD
Mailing Address - Street 2:STE. 170
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-7663
Mailing Address - Country:US
Mailing Address - Phone:916-296-8615
Mailing Address - Fax:
Practice Address - Street 1:2410 FAIR OAKS BLVD
Practice Address - Street 2:STE. 170
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-7663
Practice Address - Country:US
Practice Address - Phone:916-296-8615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 31882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor