Most Relevant Information
Provider Data
| NPI Number: | 1003031808 |
| Provider Name: | HEATHER A ELLENS |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/16/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
55475 SANTA FE TRL
YUCCA VALLEY
CA
922843117
Practice Location Phone/Fax
| Phone: | 7603653022 |
| Fax: | 7603653513 |
Provider Mailing Location
55475 SANTA FE TRL
YUCCA VALLEY
CA
922843117
Provider Mailing Phone/Fax
| Phone: | 7603653022 |
| Fax: | 7603653513 |