1205903655 NPI number — DR. JOSE R ALEMAR ULLOA

Table of content: DR. JOSE R ALEMAR ULLOA (NPI 1205903655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205903655 NPI number — DR. JOSE R ALEMAR ULLOA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALEMAR ULLOA
Provider First Name:
JOSE R
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALEMAR ULLOA
Provider Other First Name:
JOSE R
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1205903655
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 97
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SABANA GARNDE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00637-0097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-254-5009
Provider Business Mailing Address Fax Number:
787-899-4444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#38 SANTOS ORTIZ AVE
Provider Second Line Business Practice Location Address:
SAN JOSE PLAZA SUITE 104
Provider Business Practice Location Address City Name:
CABO ROJO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00623-4217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-254-5009
Provider Business Practice Location Address Fax Number:
787-899-4444
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  10327 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6230074 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4010-5 . This is a "PROSSAM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 601337 . This is a "MEDICARE Y MUCHO MAS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060564 . This is a "LA CRUZ AZUL DE PR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 209400 . This is a "PREFERRED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8-2812AL . This is a "TRIPLE S" identifier . This identifiers is of the category "OTHER".




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