Provider Demographics
NPI:1770629362
Name:ULLOA, LUZ M (PHTECH)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:M
Last Name:ULLOA
Suffix:
Gender:F
Credentials:PHTECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 914
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00951-0914
Mailing Address - Country:US
Mailing Address - Phone:787-457-9064
Mailing Address - Fax:
Practice Address - Street 1:650 AVE MUNOZ RIVERA STE 701
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4110
Practice Address - Country:US
Practice Address - Phone:787-523-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6173183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician