Individual
ELLISON PUA CONCEPCION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA MSN
Contact information
Practice address
6041 CADILLAC AVE, LOS ANGELES, CA 90034-1702
(323) 857-2000
Mailing address
6041 CADILLAC AVE, LOS ANGELES, CA 90034-1702
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
95000804
CA
Other
Enumeration date
11/09/2017
Last updated
12/08/2021
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