MEDICARE: ELITE SEDATION GENERAL PARTNERSHIP

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	1223D0004X	Dental Anesthesiology

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699405027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE SEDATION GENERAL PARTNERSHIP

Provider Business Mailing Address
First Line	:	30262 CROWN VALLEY PKWY STE B447
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-2364
Country	:	US
Telephone Number	:	949-288-3401
Fax Number	:

Provider Business Practice Location Address
First Line	:	30262 CROWN VALLEY PKWY STE B447
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-2364
Country	:	US
Telephone Number	:	949-288-3401
Fax Number	:

Authorized Official
Title or Position	:	DENTIST ANESTHESIOLOGIST
Name	:	ANDREW ELMASRI
Credential	:	DDS
Telephone Number	:	949-288-3401

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	06/17/2022

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