Provider Demographics
NPI:1386424679
Name:ELITE MEDICAL GROUP OF SOUTHERN CALIFORNIA
Entity type:Organization
Organization Name:ELITE MEDICAL GROUP OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAKER
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLAWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:774-444-1004
Mailing Address - Street 1:8816 FOOTHILL BLVD # 103-338
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7199
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8816 FOOTHILL BLVD # 103-338
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7199
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty