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Individual

MARK H. ELLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
455 S MAIN ST, ORANGE, CA 92868-3835
(714) 289-4511
(714) 289-4788
Mailing address
455 S MAIN ST, ORANGE, CA 92868-3835
(714) 289-4511
(714) 289-4788

Taxonomy

Speciality
Code
Description
License number
State
2080P0201X
Pediatric Allergy/Immunology Physician
Primary
C41445
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00C414450
CA
Enumeration date
09/20/2006
Last updated
07/08/2007
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