Fernando Ulloa, M.D.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

G49903 Issued in CA

Practice address

711 D St
Suite 113
San Rafael, CA 94901-3707

Phone

(415) 454-4100

NPI assigned

Apr 4, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 9, 2017 through Jun 9, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Marin General Hospital

  • General Acute Care Hospital
  • Greenbrae, CA
  • NPI 1396725677
  NPD (past)
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Novato, CA
  • NPI 1104059153
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124140686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1938",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949421938",
            "telephone_number": "415-454-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 D ST",
            "address_2": "SUITE 113",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013707",
            "telephone_number": "415-454-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ULLOA",
        "first_name": "FERNANDO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CA",
            "license": "G49903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G49903",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jean Tuthill, RN,CNS,WOCN
• Lydia Tuveson, PT
• Aria Twilling
• Thomas Joseph Uelk, DDS
• Tanya Uhl, CRNA
• Jody Lynn Ullom, MD
• Susan Mary Ann Ultsch, M.S.,CCC-SLP
• Madeline Underwood, MD
• Haluk E Uner, RPH,MS
• Lynda Beth Unkeless

• Pediatric Adolescent Medicine Physician in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Pediatric Adolescent Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.