| Doctor Name: | NANCY A ELLERBROEK |
| NPI Number: | 1821071507 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | G53683 |
| Business Practice Address: | 25751 Mcbean Pkwy Ste. 110 Valencia, CA - 913553701 |
| Business Phone Number: | 6612592990 |
| Business Fax Number: | 6612591031 |
| Mailing Address: | Po Box 513969, LOS ANGELES |
| State: | CA |
| Postal Code: | 900513969 |
| Phone Number: | 3103354065 |
| Fax Number: | 3103354098 |
| NPI Enumeration Date: | 11/27/2005 |
| NPI Last Update Date: | 05/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | G53683 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |