Provider Demographics
NPI:1306883590
Name:ULLOA, VICTORIA MARIA (MD)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:MARIA
Last Name:ULLOA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:COND VISTAS DEL RIO
Mailing Address - Street 2:APT 18 A
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-349-0933
Mailing Address - Fax:
Practice Address - Street 1:CALLE BUEN SAMAIITANO
Practice Address - Street 2:D 12 GARDENVILLE
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-783-0610
Practice Address - Fax:787-783-0686
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15011208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
22777ULOtherTRIPLE SSS
4875OtherPALIC PG
60950OtherCRUZ AZUL
9600206OtherHUMANA
2011218OtherPREFERRED HEALTH
4875OtherPALIC PG
22777ULOtherTRIPLE SSS