Provider Demographics
NPI:1164235313
Name:ELLERO, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ELLERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2045
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-1045
Mailing Address - Country:US
Mailing Address - Phone:951-526-2073
Mailing Address - Fax:951-834-2500
Practice Address - Street 1:26010 MCCALL BLVD STE D
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-1983
Practice Address - Country:US
Practice Address - Phone:951-526-2073
Practice Address - Fax:951-834-2500
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA933970171WH0202X
171WV0202X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171WH0202XOther Service ProvidersContractorHome Modifications
No171WV0202XOther Service ProvidersContractorVehicle Modifications