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NPI Code Detail

MEDICARE: ELLEXUS HOWARD

MEDICARE: ELLEXUS HOWARD
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
1106S00000XBehavior TechnicianCA
2103K00000XBehavior Analyst1-20-45837CA

General Provider Information

NPI Number : 1962904565
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEXUS HOWARD
Provider Business Mailing Address
First Line : PO BOX 33568
Second Line :
City : SAN DIEGO
State : CA
Zip : 92163-3568
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Provider Business Practice Location Address
First Line : 2453 GRAND CANAL BLVD STE A
Second Line :
City : STOCKTON
State : CA
Zip : 95207-8138
Country : US
Telephone Number : 855-223-7123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2018
Last Update Date : 03/01/2024

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Directions to “ ELLEXUS HOWARD ” Practice Location

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