Individual
MR. EUGENE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5801 NORTH CANYON RD, SUITE 230, SAN RAMON, CA 94583-5440
(925) 275-9910
(925) 275-9823
Mailing address
1385 HOLLOWAY AVE, SAN FRANCISCO, CA 94132-2664
(415) 867-0177
(415) 867-0177
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
3473
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
NA3473
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA0034730
BLUE SHIELD OF CA
CA
05
—
RN4261510
—
CA
Enumeration date
03/07/2007
Last updated
11/29/2021
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