Provider Demographics
NPI:1699976183
Name:ULLOA, SARAH MARIE
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MARIE
Last Name:ULLOA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:MARIE
Other - Last Name:ULLOA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15111 ENDICOTT ST
Mailing Address - Street 2:15111 ENDICOTT ST.
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-1711
Mailing Address - Country:US
Mailing Address - Phone:925-551-6739
Mailing Address - Fax:925-551-6727
Practice Address - Street 1:5325 BRODER BLVD
Practice Address - Street 2:5325 BRODER BLVD.
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3309
Practice Address - Country:US
Practice Address - Phone:925-551-6739
Practice Address - Fax:925-551-6727
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI36417106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist