Individual
MS. KANDACE MICHAELE ELLIS-BURNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
3148 MIDWAY DR STE 113, SAN DIEGO, CA 92110-4539
(619) 363-0853
(619) 362-9905
Mailing address
8910 CLAIREMONT MESA BLVD, SAN DIEGO, CA 92123-1104
(858) 514-5100
(858) 514-5190
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/02/2013
Last updated
05/05/2022
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