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General NPI Number Information
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NPI Number | 1487042859
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Entity Type | Organization
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Legal Business Name | ELITE SURGICAL SERVICES
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 05/22/2015
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Provider Practice Location Address
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Address Line | 1860 MOWRY AVE STE.#401
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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 | 510-878-4444
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Provider Business Mailing Address
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Address Line | 19197 GOLDEN VALLEY RD ST.#444
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City | CANYON COUNTRY
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State | CA
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Zip | 91387-1428
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Country | US
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Telephone | 510-556-1000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ SOLE OWNER
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Name | NOSRAT KHAJAVI
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Credential | M.D.
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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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | CA
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