Individual
MARIANO FERNANDEZ-ULLOA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
234 GOODMAN ST, CINCINNATI, OH 45267-1000
(513) 584-2146
(513) 584-0431
Mailing address
3200 BURNET AVE, 3 SOUTH, CINCINNATI, OH 45229-3019
(513) 585-5501
(513) 585-5511
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
35-04-0051-F
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000013583
ANTHEM
OH
05
—
0377702
—
OH
05
—
200038970A
—
IN
01
—
3820017
UNITED HEALTHCARE
OH
05
—
64781354
—
KY
01
—
655277
AETNA
OH
Enumeration date
10/12/2006
Last updated
12/27/2012
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