Provider Demographics
NPI:1407678030
Name:ELITE CARE CLINIC
Entity type:Organization
Organization Name:ELITE CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAILIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-813-7637
Mailing Address - Street 1:9471 VIOLET SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4246
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9471 VIOLET SUNSET AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4246
Practice Address - Country:US
Practice Address - Phone:702-813-7637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty