Individual
MATTHEW RYAN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
615 W CIVIC CENTER DR, SANTA ANA, CA 92701-4006
(714) 795-3444
Mailing address
PO BOX 299, CYPRESS, CA 90630-0299
(714) 650-6704
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-ITNBVL
CA
Other
Enumeration date
05/06/2024
Last updated
07/26/2024
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