Provider Demographics
NPI:1104803634
Name:ELIXAIR MEDICAL INC
Entity type:Organization
Organization Name:ELIXAIR MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-598-8889
Mailing Address - Street 1:10621 BLOOMFIELD ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2528
Mailing Address - Country:US
Mailing Address - Phone:562-598-8889
Mailing Address - Fax:562-598-8879
Practice Address - Street 1:10621 BLOOMFIELD ST
Practice Address - Street 2:SUITE 13
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2528
Practice Address - Country:US
Practice Address - Phone:562-598-8889
Practice Address - Fax:562-598-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01711FMedicaid
CA0604320001Medicare ID - Type UnspecifiedPROVIDER NUMBER