Provider Demographics
NPI:1326548207
Name:GONZALEZ ULLOA, JOSE LUIS (NP)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:GONZALEZ ULLOA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14936 NORTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-4025
Mailing Address - Country:US
Mailing Address - Phone:281-845-9020
Mailing Address - Fax:281-845-8990
Practice Address - Street 1:14936 NORTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-4025
Practice Address - Country:US
Practice Address - Phone:281-845-9020
Practice Address - Fax:281-845-8990
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2022-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1035653363LF0000X
TX890421163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse