Healthcare Provider Details

I. General information

NPI: 1205673456
Provider Name (Legal Business Name): ELITE SYMMETRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MONTGOMERY
IRVINE CA
92604-1928
US

IV. Provider business mailing address

PO BOX 10982
WESTMINSTER CA
92685-0982
US

V. Phone/Fax

Practice location:
  • Phone: 949-202-7634
  • Fax:
Mailing address:
  • Phone: 949-202-7634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CARLOS GUTIERREZ
Title or Position: OWNER
Credential:
Phone: 949-202-7634