Most Relevant Information
Provider Data
| NPI Number: | 1003464918 |
| Provider Name: | ELLIE R AMIROVA DAOM |
| Entity Type: | Individual |
| Taxonomy Code: | 171100000X |
| Specialty: | Acupuncturist |
| License Number: | 18642 |
Most Important Dates
| Enumeration Date: | 09/04/2019 |
| Last Updated: | 09/04/2019 |
Provider Practice Location
11340 SIR FRANCIS DRAKE DR
LA MESA
CA
919417268
Practice Location Phone/Fax
| Phone: | 6196698965 |
| Fax: |
Provider Mailing Location
11340 SIR FRANCIS DRAKE DR
LA MESA
CA
919417268
Provider Mailing Phone/Fax
| Phone: | 6196698965 |
| Fax: |