Healthcare Provider Details

I. General information

NPI: 1831960095
Provider Name (Legal Business Name): ELITE HEALTH AND BEAUTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 ENCINITAS BLVD STE 130
ENCINITAS CA
92024-8707
US

IV. Provider business mailing address

681 SAN RODOLFO DR # 1066
SOLANA BEACH CA
92075-2001
US

V. Phone/Fax

Practice location:
  • Phone: 760-478-9127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: KATIA RIQUELME
Title or Position: MANAGER
Credential: NP
Phone: 760-478-9127