Healthcare Provider Details

I. General information

NPI: 1831018258
Provider Name (Legal Business Name): ELLA GRITSAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7741 ANTELOPE HILLS DR
ANTELOPE CA
95843-2478
US

IV. Provider business mailing address

7741 ANTELOPE HILLS DR
ANTELOPE CA
95843-2478
US

V. Phone/Fax

Practice location:
  • Phone: 916-963-0168
  • Fax:
Mailing address:
  • Phone: 916-963-0168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number87918
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: