Healthcare Provider Details

I. General information

NPI: 1407214638
Provider Name (Legal Business Name): ELENA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E GUASTI RD STE 100
ONTARIO CA
91761-8661
US

IV. Provider business mailing address

3200 E GUASTI RD STE 100
ONTARIO CA
91761-8661
US

V. Phone/Fax

Practice location:
  • Phone: 909-313-2153
  • Fax: 919-413-4549
Mailing address:
  • Phone: 909-313-2153
  • Fax: 909-413-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number23682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: