Provider Demographics
NPI:1861783177
Name:ULLOA, GLENIS
Entity type:Individual
Prefix:MRS
First Name:GLENIS
Middle Name:
Last Name:ULLOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 MYERS ST
Mailing Address - Street 2:2ND.FLOOR
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3614
Mailing Address - Country:US
Mailing Address - Phone:951-358-4850
Mailing Address - Fax:
Practice Address - Street 1:3840 MYERS ST
Practice Address - Street 2:2ND.FLOOR
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3614
Practice Address - Country:US
Practice Address - Phone:951-358-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator