MEDICARE: ELITE MEDICAL AESTHETICS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1194567230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE MEDICAL AESTHETICS PLLC

Provider Business Mailing Address
First Line	:	123 E BASELINE RD STE D204
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1298
Country	:	US
Telephone Number	:	480-522-8875
Fax Number	:	844-266-9539

Provider Business Practice Location Address
First Line	:	123 E BASELINE RD STE D204
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1298
Country	:	US
Telephone Number	:	480-522-8875
Fax Number	:	844-266-9539

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ELSA CEDILLO
Credential	:	FNP
Telephone Number	:	480-522-8875

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	08/12/2025

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