Provider Demographics
NPI:1215643606
Name:MCGUFFIE-ELLER, MANDY
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:MCGUFFIE-ELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8549 DOBYNS DR
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3907
Mailing Address - Country:US
Mailing Address - Phone:619-980-5958
Mailing Address - Fax:
Practice Address - Street 1:5696 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1929
Practice Address - Country:US
Practice Address - Phone:619-980-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant