Healthcare Provider Details

I. General information

NPI: 1306987961
Provider Name (Legal Business Name): LARRY ELLERBEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15699 BAYPOINT AVE
SAN LEANDRO CA
94579-2794
US

IV. Provider business mailing address

22245 MAIN ST SUITE 200
HAYWARD CA
94541-4028
US

V. Phone/Fax

Practice location:
  • Phone: 510-895-6325
  • Fax:
Mailing address:
  • Phone: 510-727-9401
  • Fax: 510-727-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: