Healthcare Provider Details

I. General information

NPI: 1033065008
Provider Name (Legal Business Name): ELLIE DUFEK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S BEAUDRY AVE
LOS ANGELES CA
90017-1466
US

IV. Provider business mailing address

2711 ARMOUR LN
REDONDO BEACH CA
90278-5405
US

V. Phone/Fax

Practice location:
  • Phone: 213-241-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number29679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: