Healthcare Provider Details

I. General information

NPI: 1578922118
Provider Name (Legal Business Name): ELITE MEKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 WILSHIRE BLVD STE 600
LOS ANGELES CA
90010-2814
US

IV. Provider business mailing address

6596 OAK SPRINGS DR
OAK PARK CA
91377-3828
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-3550
  • Fax: 323-361-8052
Mailing address:
  • Phone: 818-590-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number102303
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: