Healthcare Provider Details

I. General information

NPI: 1538395983
Provider Name (Legal Business Name): MILANA ELLISON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 12/15/2021
Certification Date: 04/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 WEST LN
STOCKTON CA
95210-3377
US

IV. Provider business mailing address

701 N CLAYTON ST
WILMINGTON DE
19805-3165
US

V. Phone/Fax

Practice location:
  • Phone: 209-476-2000
  • Fax:
Mailing address:
  • Phone: 302-575-8040
  • Fax: 302-575-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA118011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: