Healthcare Provider Details

I. General information

NPI: 1457118705
Provider Name (Legal Business Name): ELEVATE EMERGENCY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41870 GARSTIN DR
BIG BEAR LAKE CA
92315-2088
US

IV. Provider business mailing address

41870 GARSTIN DR
BIG BEAR LAKE CA
92315-2088
US

V. Phone/Fax

Practice location:
  • Phone: 858-333-4376
  • Fax:
Mailing address:
  • Phone: 858-333-4376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: OMEED SAGHAFI
Title or Position: CFO, OWNER
Credential: MD
Phone: 858-333-4376