Healthcare Provider Details

I. General information

NPI: 1255281747
Provider Name (Legal Business Name): RHONDA ELANE ELLISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 W VICTORIA ST
LONG BEACH CA
90805-2175
US

IV. Provider business mailing address

1310 VAL VISTA ST
POMONA CA
91768-1336
US

V. Phone/Fax

Practice location:
  • Phone: 323-836-8183
  • Fax:
Mailing address:
  • Phone: 909-241-1912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: