Provider Demographics
NPI:1205903655
Name:ALEMAR ULLOA, JOSE R
Entity type:Individual
Prefix:DR
First Name:JOSE R
Middle Name:
Last Name:ALEMAR ULLOA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JOSE R
Other - Middle Name:
Other - Last Name:ALEMAR ULLOA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:SABANA GARNDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-0097
Mailing Address - Country:US
Mailing Address - Phone:787-254-5009
Mailing Address - Fax:787-899-4444
Practice Address - Street 1:#38 SANTOS ORTIZ AVE
Practice Address - Street 2:SAN JOSE PLAZA SUITE 104
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-4217
Practice Address - Country:US
Practice Address - Phone:787-254-5009
Practice Address - Fax:787-899-4444
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10327207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
6230074OtherHUMANA
4010-5OtherPROSSAM
601337OtherMEDICARE Y MUCHO MAS
060564OtherLA CRUZ AZUL DE PR
209400OtherPREFERRED HEALTH
8-2812ALOtherTRIPLE S
D-50612Medicare UPIN
4010-5OtherPROSSAM