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NPI Code Detail

MEDICARE: ADELL M ELLIS

MEDICARE: ADELL M ELLIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1373H00000XDay Training/Habilitation Specialist

General Provider Information

NPI Number : 1497837108
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADELL M ELLIS
Provider Business Mailing Address
First Line : 9444 TWIN TRAILS DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92129-2633
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3211 JEFFERSON ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-4424
Country : US
Telephone Number : 619-683-3100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 07/08/2007

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Directions to “ ADELL M ELLIS ” Practice Location

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