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Individual

KEITH ROMALIS ELLISON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MA, ATC, CES

Contact information

Practice address
ONE LMU DRIVE, GERSTEN PAVILION - ATHLETIC TRAINING ROOM, LOS ANGELES, CA 90045
(424) 789-4071
(310) 338-4401
Mailing address
ONE LMU DRIVE, GERSTEN PAVILION - ATHLETIC TRAINING ROOM, LOS ANGELES, CA 90045
(424) 789-4071

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
CA

Other

Enumeration date
03/08/2016
Last updated
03/08/2016
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