Healthcare Provider Details

I. General information

NPI: 1891962155
Provider Name (Legal Business Name): MAURICE ELIHU MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E SUITE 1804
LOS ANGELES CA
90067-2001
US

IV. Provider business mailing address

PO BOX 7579
BEVERLY HILLS CA
90212-7579
US

V. Phone/Fax

Practice location:
  • Phone: 310-551-9900
  • Fax: 310-551-9920
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA88076
License Number StateCA

VIII. Authorized Official

Name: MAURICE ELIHU
Title or Position: PRESIDENT
Credential: MD
Phone: 310-551-9900