Provider Demographics
NPI:1336238484
Name:ADULT MEDICINE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:ADULT MEDICINE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:ULLOA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-627-7766
Mailing Address - Street 1:18 CAMBRIA RD E
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-7027
Mailing Address - Country:US
Mailing Address - Phone:561-627-7766
Mailing Address - Fax:561-745-7876
Practice Address - Street 1:601 UNIVERSITY BLVD
Practice Address - Street 2:207
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-627-7766
Practice Address - Fax:561-745-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD85408Medicare UPIN
FLAB598AMedicare PIN