Individual
ERNESTO ULLOA-JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
10845 BLOOMINGDALE AVE, RIVERVIEW, FL 33578-3616
(813) 662-6100
Mailing address
5320 S WEST SHORE BLVD APT 3406, TAMPA, FL 33611-5654
(813) 297-5497
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
25501
FL
Other
Enumeration date
09/29/2020
Last updated
09/29/2020
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