Individual
MARIA GULTOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 UCLA MEDICAL PLZ STE 630, LOS ANGELES, CA 90024-6997
(310) 794-1276
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
(310) 267-9536
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
95002729
CA
363LA2100X
Acute Care Nurse Practitioner
95002729
CA
Other
Enumeration date
07/16/2015
Last updated
07/07/2020
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