Provider Demographics
NPI:1790854545
Name:ULLOA, ELKE OJEDA (PA-C)
Entity Type:Individual
Prefix:
First Name:ELKE
Middle Name:OJEDA
Last Name:ULLOA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELKE
Other - Middle Name:
Other - Last Name:OJEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:1150 N 35TH AVE STE 555
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5431
Practice Address - Country:US
Practice Address - Phone:954-265-0072
Practice Address - Fax:954-981-0188
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102956363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9102956OtherLICENSE
FLU4116ZMedicare PIN