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DR. FERNANDO ULLOA M.D.
NPI 1124140686
Pediatrics - Adolescent Medicine in San Rafael, CA

Active since April 04, 2007Opted out of Medicare · through Jun 9, 2027
711 D ST, SUITE 113, SAN RAFAEL, CA 94901(415) 454-4100 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Fernando Ulloa M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. FERNANDO ULLOA M.D. (NPI 1124140686) is an individual adolescent medicine provider in San Rafael, California, licensed in California (G49903) and active in the NPI registry since April 2007. He has opted out of Medicare through June 9, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1124140686
Entity TypeIndividualMale
Primary Taxonomy2080A0000X
Provider Legal NameDR. FERNANDO ULLOACredential: M.D.
Location Address711 D ST, SUITE 113San Rafael, CA 94901-3707
Mailing AddressPo Box 1938Mill Valley, CA 94942-1938 · (415) 454-4100
Phone(415) 454-4100
Sole ProprietorYes
Enumeration DateApril 4, 2007
Last NPPES UpdateJuly 8, 2007
✔ NPI 1124140686 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080A0000X
License✔ Licensed in CA · G49903
Definition
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
711 D ST, San Rafael, CA 94901
Open in Google Maps ↗

Other Identifiers 1

Medicaid00G49903CA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Fernando Ulloa M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from June 9, 2017 through June 9, 2027.

Opt-Out Effective DateJune 9, 2017
Opt-Out In Effect ThroughJune 9, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Male external catheter, with or without adhesive, disposable, each A4349
DME-Medical/Surgical Supplies · category DA000N
1 supplier11 claims385 services$1.75 avg. paid by Medicare
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each A4358
DME-Orthotic Devices · category DF000N
1 supplier11 claims22 services$4.47 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

YEVGENIYA V GARANINA
Counselor (Mental Health)
711 D ST
SAN RAFAEL, CA 94901
Marin County (415) 515-3279
DR. ANN GOLD BUSCHO PH.D.
Psychologist
711 D ST, SUITE 207
SAN RAFAEL, CA 94901
Marin County (415) 456-0952
DR. JEFFREY I FRIEDMAN DC
Chiropractor
711 D ST, SUITE 104
SAN RAFAEL, CA 94901
Marin County (415) 459-4646
MS. LINDA SILVER LMFT
Counselor (Mental Health)
711 D ST, #201
SAN RAFAEL, CA 94901
Marin County (415) 257-8872
MR. STEPHEN M GROSS M.A.
Marriage & Family Therapist
711 D ST, SUITE 201
SAN RAFAEL, CA 94901
Marin County (415) 258-0449
MR. KENNETH A TUCKER P.T.
Physical Therapist
711 D ST, #102
SAN RAFAEL, CA 94901
Marin County (415) 456-3551
MARIA LOURDES QUESADA MFT
Marriage & Family Therapist
711 D ST
SAN RAFAEL, CA 94901
Marin County (415) 517-1309
DR. JOHN WEIR PH.D.
Psychologist
711 D ST, #209
SAN RAFAEL, CA 94901
Marin County (415) 457-8886

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fernando Ulloa's NPI number?

The NPI number for Fernando Ulloa is 1124140686. It was assigned to this individual provider in the NPPES registry on April 4, 2007.

Where is Fernando Ulloa located?

Fernando Ulloa practices at 711 D St Suite 113, San Rafael, CA 94901. The listed phone number is (415) 454-4100.

What is Fernando Ulloa's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

Is Fernando Ulloa enrolled in Medicare?

No. Fernando Ulloa has opted out of Medicare through June 9, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Fernando Ulloa was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.