Healthcare Provider Details

I. General information

NPI: 1023939261
Provider Name (Legal Business Name): ELITE CARE MOBILE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 E FLAMINGO RD STE J3
LAS VEGAS NV
89121-5209
US

IV. Provider business mailing address

2950 E FLAMINGO RD STE J3
LAS VEGAS NV
89121-5209
US

V. Phone/Fax

Practice location:
  • Phone: 510-520-3369
  • Fax:
Mailing address:
  • Phone: 510-520-3369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTONIO LUIS DE PERALTA
Title or Position: PRESIDENT
Credential: NP
Phone: 510-520-3369