Active NPI
Camille Rose Ellis
- Speech-Language Pathologist
- Norco, CA
National Provider Identifier
1740111574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 39762
- Practice address
- 1761 3Rd St Ste 106
Norco, CA 92860-2679 - Phone
- (626) 536-4834
- NPI assigned
- May 28, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 39762 | CA | Primary |
Addresses
Primary practice location
1761 3Rd St Ste 106
Norco, CA 92860-2679
Mailing address
414 E San Bernardino Rd
Covina, CA 91723-1704
Phone (626) 367-3206
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39762 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1779926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779926400000",
"number": "1740111574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "414 E SAN BERNARDINO RD",
"city": "COVINA",
"state": "CA",
"postal_code": "917231704",
"telephone_number": "626-367-3206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1761 3RD ST STE 106",
"city": "NORCO",
"state": "CA",
"postal_code": "928602679",
"telephone_number": "626-536-4834"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "CAMILLE",
"middle_name": "ROSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-05-28",
"last_updated": "2026-05-28",
"certification_date": "2026-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "39762",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.