Healthcare Provider Details

I. General information

NPI: 1528947264
Provider Name (Legal Business Name): NATALIA GEPALAGA ELLISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIA ELLISON

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SNEATH LN STE 105
SAN BRUNO CA
94066-2415
US

IV. Provider business mailing address

PO BOX 33568
SAN DIEGO CA
92163-3568
US

V. Phone/Fax

Practice location:
  • Phone: 855-223-7123
  • Fax:
Mailing address:
  • Phone: 855-223-7123
  • Fax: 619-374-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: