Healthcare Provider Details

I. General information

NPI: 1477477719
Provider Name (Legal Business Name): ELIJAH J WEBBER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15027 VAN BUREN AVE
GARDENA CA
90247-3042
US

IV. Provider business mailing address

15027 VAN BUREN AVE
GARDENA CA
90247-3042
US

V. Phone/Fax

Practice location:
  • Phone: 310-864-7629
  • Fax:
Mailing address:
  • Phone: 310-864-7629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberF8067335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: