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General NPI Number Information
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NPI Number | 1417401548
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Entity Type | Organization
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Legal Business Name | ELITE PROVIDER URGENT CARE NETWORK PC
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Dates
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Enumeration Date | 08/05/2016
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 201 S ALVARADO ST STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90057-2320
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Country | US
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Telephone | 213-989-1900
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Fax | 213-989-1923
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Provider Business Mailing Address
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Address Line | 201 S ALVARADO ST STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90057-2320
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Country | US
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Telephone | 213-989-1900
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Fax | 213-989-1923
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Authorized Official
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Title or Position | CEO
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Name | JUAN A. SILVA
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Credential | M.D.
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Telephone | 323-376-0335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State | CA
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