Provider Demographics
NPI:1285655902
Name:ULRICH, SKYLAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SKYLAR
Middle Name:
Last Name:ULRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 TAMAL VISTA BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1130
Mailing Address - Country:US
Mailing Address - Phone:415-927-7660
Mailing Address - Fax:415-927-7663
Practice Address - Street 1:21 TAMAL VISTA BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1130
Practice Address - Country:US
Practice Address - Phone:415-927-7660
Practice Address - Fax:415-927-7663
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73335207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH26616Medicare UPIN