Individual
LISA MARIE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9890 COUNTY FARM RD STE 3, RIVERSIDE, CA 92503-3678
(951) 509-8320
Mailing address
4575 LYON AVE, RIVERSIDE, CA 92505-3454
(951) 224-1263
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/27/2021
Last updated
01/27/2021
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