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General NPI Number Information
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NPI Number | 1760340657
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Entity Type | Organization
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Legal Business Name | EZE ELITAIRE LLC
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 1704 W MANCHESTER AVE STE 210A
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City | LOS ANGELES
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State | CA
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Zip | 90047-3063
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Country | US
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Telephone | 310-923-9553
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Fax |
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Provider Business Mailing Address
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Address Line | 1704 W MANCHESTER AVE STE 210A
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City | LOS ANGELES
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State | CA
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Zip | 90047-3063
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Country | US
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Telephone | 310-923-9553
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | SAMADRA MONIQUE EMBRY
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Credential |
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Telephone | 424-444-8598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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