Healthcare Provider Details

I. General information

NPI: 1841018553
Provider Name (Legal Business Name): ELITEMEDCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 NORTHBROOKE PLAZA DR SUITE #207
NAPLES FL
34119
US

IV. Provider business mailing address

2338 IMMOKALEE RD STE 203
NAPLES FL
34110-1445
US

V. Phone/Fax

Practice location:
  • Phone: 239-919-4342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CARLOS GUTIERREZ-HEVIA
Title or Position: OWNER
Credential: MD
Phone: 238-919-4342