Provider Demographics
NPI:1871838813
Name:ULLOA-SOLTSOV, SARAH MIRIAM
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MIRIAM
Last Name:ULLOA-SOLTSOV
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:MIRIAM
Other - Last Name:ULLOA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2313 62ND ST
Mailing Address - Street 2:APT. 1F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2626
Mailing Address - Country:US
Mailing Address - Phone:646-361-9860
Mailing Address - Fax:
Practice Address - Street 1:2313 62ND ST
Practice Address - Street 2:APT. 1F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-2626
Practice Address - Country:US
Practice Address - Phone:646-361-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health