Healthcare Provider Details

I. General information

NPI: 1831857937
Provider Name (Legal Business Name): ELENA DAVIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
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: 909-413-4549
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 Number
License Number State

VIII. Authorized Official

Name: ELENA DAVIS
Title or Position: CEO
Credential:
Phone: 909-313-2153