Individual
JESUS GILDARDO ULLOA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 UCLA MEDICAL PLZ STE 526, LOS ANGELES, CA 90095-0001
(310) 206-6294
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
A123518
CA
2086S0129X
Vascular Surgery Physician
Primary
A123518
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2011
Last updated
07/20/2021
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