Individual
MR. ANTHONY JEROME ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.P.
Contact information
Practice address
923 W FOOTHILL BLVD, UPLAND, CA 91786-3729
(909) 982-3434
Mailing address
923 W FOOTHILL BLVD, UPLAND, CA 91786-3729
(909) 982-3434
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
CA
Other
Enumeration date
05/24/2011
Last updated
05/24/2011
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