Provider Demographics
NPI:1568535730
Name:ULLOA, ELIZABETH (LMP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:ULLOA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:CARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1111 N NORTHGATE WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8913
Mailing Address - Country:US
Mailing Address - Phone:206-523-2225
Mailing Address - Fax:206-523-9101
Practice Address - Street 1:1111 N NORTHGATE WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8913
Practice Address - Country:US
Practice Address - Phone:206-523-2225
Practice Address - Fax:206-523-9101
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016797225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist