Individual
DR. FERNANDO ULLOA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
711 D ST, SUITE 113, SAN RAFAEL, CA 94901-3707
(415) 454-4100
Mailing address
PO BOX 1938, MILL VALLEY, CA 94942-1938
(415) 454-4100
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
G49903
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G49903
—
CA
Enumeration date
04/04/2007
Last updated
07/08/2007
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