Provider Demographics
NPI:1467289884
Name:ELITE SPECIALTY SURGERY CENTER OF CHULA VISTA, LLC
Entity type:Organization
Organization Name:ELITE SPECIALTY SURGERY CENTER OF CHULA VISTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLOUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-616-7641
Mailing Address - Street 1:1045 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4616
Mailing Address - Country:US
Mailing Address - Phone:760-884-4500
Mailing Address - Fax:619-567-7775
Practice Address - Street 1:256 LANDIS AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2650
Practice Address - Country:US
Practice Address - Phone:619-616-7641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty