Provider Demographics
NPI:1407482193
Name:ULLOA, CYNTHIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:ULLOA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17915 CRENSHAW BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-4131
Mailing Address - Country:US
Mailing Address - Phone:714-496-1966
Mailing Address - Fax:
Practice Address - Street 1:17915 CRENSHAW BLVD APT 4
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-4131
Practice Address - Country:US
Practice Address - Phone:714-496-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21034225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist