Individual
ANNIE ULLOA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
243 E 6100 S, MURRAY, UT 84107-7302
(801) 581-2955
Mailing address
243 E 6100 S, MURRAY, UT 84107-7302
(801) 581-2955
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
12620200-1109
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12620200-1109
MASTER ESTHETICIAN
UT
Enumeration date
08/16/2022
Last updated
08/16/2022
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