=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033390513
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRET JAMES ELLINGTON L.AC.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2007
-----------------------------------------------------
Last Update Date | 02/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22762 ASPAN ST SUITE 201
-----------------------------------------------------
City | LAKE FOREST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92630-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-235-9494
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23785 EL TORO RD SUITE 111
-----------------------------------------------------
City | LAKE FOREST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92630-4762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-235-9494
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC 11948
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------