Healthcare Provider Details

I. General information

NPI: 1255739058
Provider Name (Legal Business Name): ELLEN R SILVER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 E HOLT AVE
POMONA CA
91767-5822
US

IV. Provider business mailing address

1450 E HOLT AVE
POMONA CA
91767-5822
US

V. Phone/Fax

Practice location:
  • Phone: 909-865-9501
  • Fax: 909-620-6795
Mailing address:
  • Phone: 909-865-9501
  • Fax: 909-620-6795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number5298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: