Healthcare Provider Details

I. General information

NPI: 1679706386
Provider Name (Legal Business Name): ELILTA M. HAGOS M.D., M.P.H
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 W 117TH ST STE 200
HAWTHORNE CA
90250-2240
US

IV. Provider business mailing address

4455 W 117TH ST STE 200
HAWTHORNE CA
90250-2240
US

V. Phone/Fax

Practice location:
  • Phone: 310-219-2000
  • Fax:
Mailing address:
  • Phone: 310-219-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA121648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: