MEDICARE: RANELL ELMORE

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
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1518025444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANELL ELMORE

Provider Business Mailing Address
First Line	:	3351 INLAND EMPIRE BLVD
Second Line	:	17D
City	:	ONTARIO
State	:	CA
Zip	:	91764-4866
Country	:	US
Telephone Number	:	909-522-0699
Fax Number	:	909-980-8708

Provider Business Practice Location Address
First Line	:	1200 S CENTRAL AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-2504
Country	:	US
Telephone Number	:	909-522-0699
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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Directions to “ RANELL ELMORE ” Practice Location

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