Organization
ELLINGTON MEDICAL SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMAR STAPLES PA (OWNER/PHYSICIAN ASSISTANT)
(510) 225-3977
Entity
Organization
Contact information
Practice address
5715 MARKET ST, OAKLAND, CA 94608-2811
(510) 225-3977
(510) 915-3038
Mailing address
5715 MARKET ST, OAKLAND, CA 94608-2811
(510) 225-3977
(510) 915-3038
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 16192
CA
Other
Enumeration date
03/17/2015
Last updated
07/07/2015
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