Basic Information
| Provider Information | |||||||||
| NPI: | 1710436126 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ULLOA | ||||||||
| FirstName: | GABRIELLA | ||||||||
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| Credential: | M.A., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6551 WARNER AVE | ||||||||
| Address2: | APT 188 | ||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926475249 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4001 WESTERLY PL | ||||||||
| Address2: | 110 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926602315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497568799 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2016 | ||||||||
| LastUpdateDate: | 09/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-16-23525 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.