Individual
ANTHONY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2105 FOREST AVE, SAN JOSE, CA 95128-1425
(408) 947-2500
Mailing address
44280 REVERE PL, FREMONT, CA 94539-5902
(510) 387-7011
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95007645
CA
Other
Enumeration date
10/07/2017
Last updated
10/07/2017
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