Provider Demographics
NPI:1821370248
Name:YULO, JOSE BALLEZA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:BALLEZA
Last Name:YULO
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 1:27 COLLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8922
Mailing Address - Country:US
Mailing Address - Phone:386-445-8791
Mailing Address - Fax:386-445-8791
Practice Address - Street 1:24 AUTUMN LN
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-6321
Practice Address - Country:US
Practice Address - Phone:386-445-8791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137875207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology