Provider Demographics
NPI:1447964903
Name:RAUL ULLOA MEDICAL PC
Entity type:Organization
Organization Name:RAUL ULLOA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HILARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-773-2505
Mailing Address - Street 1:2230 TENBROECK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5414
Mailing Address - Country:US
Mailing Address - Phone:917-773-2505
Mailing Address - Fax:
Practice Address - Street 1:6914 41ST AVE # C2
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4028
Practice Address - Country:US
Practice Address - Phone:917-773-2505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty