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NPI Code Detail

MEDICARE: BOBBY ELLIS

MEDICARE: BOBBY ELLIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171400000XHealth & Wellness CoachAZ

General Provider Information

NPI Number : 1639912348
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOBBY ELLIS
Provider Business Mailing Address
First Line : 1616 N CENTRAL AVE 2361
Second Line :
City : PHOENIX
State : AZ
Zip : 85004-1668
Country : US
Telephone Number : 323-527-3538
Fax Number :
Provider Business Practice Location Address
First Line : 2325 E CAMELBACK RD STE 400
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-3514
Country : US
Telephone Number : 954-951-3482
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2024
Last Update Date : 06/18/2024

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Directions to “ BOBBY ELLIS ” Practice Location

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