Individual
MR. GLEN STEPHEN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.P.O.
Contact information
Practice address
3553 CASTRO VALLEY BLVD, SUITE B, CASTRO VALLEY, CA 94546-4400
(510) 537-1210
(510) 537-1082
Mailing address
2260 JEFFREY ST, LIVERMORE, CA 94550-6463
(925) 606-9295
(925) 606-7855
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
02/01/2007
Last updated
07/08/2007
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