Healthcare Provider Details

I. General information

NPI: 1598852063
Provider Name (Legal Business Name): DAVID E. ELY R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST STE 550
SANTA ANA CA
92701-4519
US

IV. Provider business mailing address

1201 FAIRHAVEN AVE APT. 16-F
SANTA ANA CA
92705-6767
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-4707
  • Fax:
Mailing address:
  • Phone: 714-321-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN305936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: