Provider Demographics
NPI:1528879400
Name:BAKLASH, ELLAH
Entity type:Individual
Prefix:
First Name:ELLAH
Middle Name:
Last Name:BAKLASH
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 1:24137 DEL MONTE DR UNIT 226
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3395
Mailing Address - Country:US
Mailing Address - Phone:661-600-6440
Mailing Address - Fax:
Practice Address - Street 1:24137 DEL MONTE DR UNIT 226
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3395
Practice Address - Country:US
Practice Address - Phone:661-600-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950335812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry