Healthcare Provider Details

I. General information

NPI: 1841710092
Provider Name (Legal Business Name): ELITE MEDICAL PROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28975 OLD TOWN FRONT ST STE 200
TEMECULA CA
92590-2863
US

IV. Provider business mailing address

4511 ROSEMEAD BLVD STE 200
PICO RIVERA CA
90660-2032
US

V. Phone/Fax

Practice location:
  • Phone: 951-719-3111
  • Fax: 951-719-3111
Mailing address:
  • Phone: 951-719-3111
  • Fax: 951-719-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: YVONNE M LOPEZ
Title or Position: MANAGER
Credential:
Phone: 951-719-3111