Active NPI
Brianda Ulloa
- Physician Assistant
- Rancho Cucamonga, CA
National Provider Identifier
1770188468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 58807
- Practice address
- 9170 Haven Ave Ste 120
Rancho Cucamonga, CA 91730-5416 - Phone
- (909) 476-8700
- NPI assigned
- Dec 1, 2020
- Last updated
- Aug 14, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Physician Assistant | 363A00000X | 58807 | CA | Primary |
Addresses
Primary practice location
9170 Haven Ave Ste 120
Rancho Cucamonga, CA 91730-5416
Mailing address
9170 Haven Ave Ste 120
Rancho Cucamonga, CA 91730-5416
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58807 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tele-Medicine Services Ny, PLLC | Past | Accepting new patients | |
| Jayapal a Reddy MD and Radha T Reddy MD Inc | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- telemed2u.briandaulloa@160918.advancedmd-direct.com
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba TeleMed2U
- Emergency Medicine Physician
- Roseville, CA
- NPI 1326338237
-
- Specialist
- Rancho Cucamonga, CA
- NPI 1881937068
-
- Internal Medicine Physician
- Roseville, CA
- NPI 1609663780
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723593600000",
"number": "1770188468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9170 HAVEN AVE STE 120",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917305416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9170 HAVEN AVE STE 120",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917305416",
"telephone_number": "909-476-8700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ULLOA",
"first_name": "BRIANDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-01",
"last_updated": "2024-08-14",
"certification_date": "2024-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "58807",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.