MEDICARE: ELITE CARE CLINIC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1407678030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE CARE CLINIC

Provider Business Mailing Address
First Line	:	9471 VIOLET SUNSET AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4246
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9471 VIOLET SUNSET AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4246
Country	:	US
Telephone Number	:	702-813-7637
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAILIN LEON LOPEZ
Credential	:
Telephone Number	:	702-813-7637

Provider Enumeration Date	:	10/25/2024
Last Update Date	:	10/25/2024

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Directions to “ELITE CARE CLINIC ” Practice Location

Language	Start Address	Practice Location

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