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General NPI Number Information
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NPI Number | 1265829006
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Entity Type | Organization
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Legal Business Name | ELITE MEDICAL SERVICES
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 1860 MOWRY AVE SUITE 402
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City | FREMONT
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State | CA
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Zip | 94538-1730
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Country | US
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Telephone | 510-556-1000
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Fax | 888-876-1676
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Provider Business Mailing Address
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Address Line | 39120 ARGONAUT WAY SUITE 706
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City | FREMONT
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State | CA
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Zip | 94538-1304
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Country | US
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Telephone | 510-556-1000
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Fax | 888-876-1676
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Authorized Official
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Title or Position | OWNER
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Name | NOSRAT KHAJAVI
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Credential | DO
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Telephone | 510-556-1000
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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 | 6223
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License Number State | CA
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