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General NPI Number Information
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NPI Number | 1003907916
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Entity Type | Individual
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Provider Name | LAURENCE STEVEN ELLNER DPM
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 11/12/2012
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Provider Practice Location Address
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Address Line | 2287 MOWRY AVE STE C
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City | FREMONT
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State | CA
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Zip | 94538-1622
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Country | US
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Telephone | 510-713-6559
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Fax | 510-713-6537
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Provider Business Mailing Address
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Address Line | 2287 MOWRY AVE STE C
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City | FREMONT
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State | CA
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Zip | 94538-1622
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Country | US
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Telephone | 510-713-6559
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Fax | 510-713-6537
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E3746
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License Number State | CA
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