MEDICARE: ELITE DIAGNOSTICS MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	C35757	CA

General Provider Information

NPI Number	:	1134446024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE DIAGNOSTICS MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 940700
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93094-0700
Country	:	US
Telephone Number	:	818-893-7500
Fax Number	:	818-893-4425

Provider Business Practice Location Address
First Line	:	1445 E LOS ANGELES AVE
Second Line	:	SUITE 203
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-2817
Country	:	US
Telephone Number	:	818-893-7500
Fax Number	:	818-893-4425

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. STEPHEN ANDREW SCHWARTZ
Credential	:	M.D.
Telephone Number	:	818-893-7500

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	04/30/2010

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