Provider Demographics
NPI:1518005289
Name:ULIT, WAYNE JACINTO (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:JACINTO
Last Name:ULIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24108 HATTERAS ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4038
Mailing Address - Country:US
Mailing Address - Phone:213-413-8765
Mailing Address - Fax:213-353-9375
Practice Address - Street 1:2105 BEVERLY BLVD
Practice Address - Street 2:SUITE125
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2216
Practice Address - Country:US
Practice Address - Phone:213-413-8765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine