# KARLIS ULLIS, M.D., A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sports Medicine & Preventive Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265674485
- **Authorized official:** DR. KARLIS CONRAD ULLIS M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (310) 452-1990

## Contact information

- **Practice address:** 900 WILSHIRE BLVD, SUITE 425, SANTA MONICA, CA 90401-1872
- **Practice address phone:** (310) 452-1990
- **Practice address fax:** (310) 452-5134
- **Mailing address:** 900 WILSHIRE BLVD, SUITE 425, SANTA MONICA, CA 90401-1872
- **Mailing address phone:** (310) 452-1990
- **Mailing address fax:** (310) 452-5134

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | G20989 | CA | Yes |
| 2083S0010X | Sports Medicine (Preventive Medicine) Physician | G20989 | CA | — |

## Other

- **Enumeration date:** 04/02/2009
- **Last updated:** 03/07/2014