Healthcare Provider Details

I. General information

NPI: 1194667097
Provider Name (Legal Business Name): ELITECARE SVCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27462 PORTOLA PKWY STE 100
FOOTHILL RANCH CA
92610-2838
US

IV. Provider business mailing address

27462 PORTOLA PKWY STE 100
FOOTHILL RANCH CA
92610-2838
US

V. Phone/Fax

Practice location:
  • Phone: 949-624-7171
  • Fax: 949-624-7171
Mailing address:
  • Phone: 949-624-7171
  • Fax: 949-624-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: TRON V NGO
Title or Position: OWNER
Credential:
Phone: 714-769-4066