Individual
MR. ZACKRY CALVIN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
307 PLACENTIA AVE STE 111, NEWPORT BEACH, CA 92663-3307
(949) 722-1112
Mailing address
307 PLACENTIA AVE STE 111, NEWPORT BEACH, CA 92663-3307
(949) 722-1112
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA18593
CA
Other
Enumeration date
10/03/2006
Last updated
10/23/2021
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