Individual
MARCO ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2409 CAMINO RAMON, SAN RAMON, CA 94583-4285
(925) 327-6619
Mailing address
2409 CAMINO RAMON, SAN RAMON, CA 94583-4285
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
753980
CA
Other
Enumeration date
09/09/2019
Last updated
09/09/2019
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