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General NPI Number Information
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NPI Number | 1225838071
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Entity Type | Organization
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Legal Business Name | ELITE PRIMARY CARE LLC
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 1585 SW MARLOW AVE STE 220
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City | PORTLAND
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State | OR
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Zip | 97225-5178
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Country | US
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Telephone | 503-922-2888
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Fax | 971-402-1727
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Provider Business Mailing Address
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Address Line | 1585 SW MARLOW AVE STE 220
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City | PORTLAND
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State | OR
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Zip | 97225-5178
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Country | US
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Telephone | 503-922-2888
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | POONAM WALIA CHHIBBER
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Credential | MD
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Telephone | 503-704-6726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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