Provider Demographics
NPI:1326231747
Name:LUIS S. ULLOA MDPA
Entity Type:Organization
Organization Name:LUIS S. ULLOA MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:ULLOA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-627-7766
Mailing Address - Street 1:601 UNIVERSITY BLVD
Mailing Address - Street 2:SIUTE #202
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2788
Mailing Address - Country:US
Mailing Address - Phone:561-627-7766
Mailing Address - Fax:561-691-4865
Practice Address - Street 1:3370 BURNS RD
Practice Address - Street 2:SUITE#105
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4327
Practice Address - Country:US
Practice Address - Phone:561-627-7766
Practice Address - Fax:561-691-4865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D85408Medicare PIN