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General NPI Number Information
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NPI Number | 1821071507
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Entity Type | Individual
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Provider Name | NANCY A ELLERBROEK
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Gender | Female
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Dates
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Enumeration Date | 11/27/2005
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Last Update Date | 05/29/2015
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Provider Practice Location Address
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Address Line | 25751 MCBEAN PKWY STE. 110
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City | VALENCIA
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State | CA
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Zip | 91355-3701
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Country | US
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Telephone | 661-259-2990
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Fax | 661-259-1031
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Provider Business Mailing Address
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Address Line | PO BOX 513969
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City | LOS ANGELES
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State | CA
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Zip | 90051-3969
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Country | US
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Telephone | 310-335-4065
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Fax | 310-335-4098
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | G53683
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | G53683
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License Number State | CA
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