Provider Demographics
NPI:1154836120
Name:ULLOA, LOUIE SHON
Entity Type:Individual
Prefix:
First Name:LOUIE
Middle Name:SHON
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 1:3316 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-1537
Mailing Address - Country:US
Mailing Address - Phone:323-722-4529
Mailing Address - Fax:323-722-4450
Practice Address - Street 1:3316 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-1537
Practice Address - Country:US
Practice Address - Phone:323-722-4529
Practice Address - Fax:323-722-4450
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist