Provider Demographics
NPI:1336924133
Name:NEUROELITE SERVICES LLC
Entity type:Organization
Organization Name:NEUROELITE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHENIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-412-1454
Mailing Address - Street 1:813 N LENZ DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-1728
Mailing Address - Country:US
Mailing Address - Phone:562-412-1454
Mailing Address - Fax:
Practice Address - Street 1:813 N LENZ DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-1728
Practice Address - Country:US
Practice Address - Phone:562-412-1454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty