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General NPI Number Information
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NPI Number | 1518583756
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Entity Type | Individual
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Provider Name | JENNIFER ELLIOTT
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Gender | Female
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Dates
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Enumeration Date | 06/23/2020
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 18624 DEL RIO PL UNIT D
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City | CERRITOS
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State | CA
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Zip | 90703-9109
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Country | US
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Telephone | 562-387-3685
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Fax |
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Provider Business Mailing Address
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Address Line | 11138 E DEL AMO BLVD 262
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City | LAKEWOOD
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State | CA
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Zip | 90715
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Country | US
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Telephone | 562-387-3685
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Fax |
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 2357859
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License Number State | CA
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