Individual
GINA L ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP, MMT, LMT
Contact information
Practice address
2228 FENTON PKWY APT 202, SAN DIEGO, CA 92108-4779
(480) 245-0343
Mailing address
2228 FENTON PKWY APT 202, SAN DIEGO, CA 92108-4779
(480) 245-0343
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
35392
CA
Other
Enumeration date
02/06/2020
Last updated
02/06/2020
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