Healthcare Provider Details

I. General information

NPI: 1699405027
Provider Name (Legal Business Name): ELITE SEDATION GENERAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30262 CROWN VALLEY PKWY STE B447
LAGUNA NIGUEL CA
92677-2364
US

IV. Provider business mailing address

30262 CROWN VALLEY PKWY STE B447
LAGUNA NIGUEL CA
92677-2364
US

V. Phone/Fax

Practice location:
  • Phone: 949-288-3401
  • Fax:
Mailing address:
  • Phone: 949-288-3401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State

VIII. Authorized Official

Name: ANDREW ELMASRI
Title or Position: DENTIST ANESTHESIOLOGIST
Credential: DDS
Phone: 949-288-3401