Kandace Michaele Ellis-Burnett, BA

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

3148 Midway Dr Ste 113
San Diego, CA 92110-4539

Phone

(619) 363-0853

Fax

(619) 362-9905

NPI assigned

Apr 2, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Kandace Michaele Ellis Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651708800000",
    "number": "1215270889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8910 CLAIREMONT MESA BLVD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231104",
            "telephone_number": "858-514-5100",
            "fax_number": "858-514-5190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3148 MIDWAY DR STE 113",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921104539",
            "telephone_number": "619-363-0853",
            "fax_number": "619-362-9905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS-BURNETT",
        "first_name": "KANDACE",
        "middle_name": "MICHAELE",
        "name_prefix": "Ms.",
        "credential": "BA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-02",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KANDACE",
            "last_name": "ELLIS",
            "middle_name": "MICHAELE",
            "prefix": "MISS",
            "credential": "BA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Rolf Robin Elliott
• Ryan Elliott
• Helena Ellis DO Amaral
• Christian Danyell Ellis Frederick, LCSW, CCM
• Robin Kaye Ellis-Browning
• Adell M Ellis
• Aliyah Ellis
• Amy Ellis, PSYD
• Angela Ellis, DO
• Brynn L. Ellis

• Peer Specialist in San Diego, CA
• Providers in San Diego, CA by specialty
• Peer Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.