Individual
CHARLES ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
835 25TH ST, SAN DIEGO, CA 92102-2738
(619) 239-9691
Mailing address
835 25TH ST, SAN DIEGO, CA 92102-2738
(619) 239-9691
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
R1527390923
CA
Other
Enumeration date
11/09/2023
Last updated
11/09/2023
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