Provider Demographics
NPI:1043228224
Name:AGATEP, ELMO MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ELMO
Middle Name:MICHAEL
Last Name:AGATEP
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19582 BEACH BLVD STE 219
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5923
Mailing Address - Country:US
Mailing Address - Phone:714-477-8190
Mailing Address - Fax:714-477-8191
Practice Address - Street 1:19582 BEACH BLVD STE 219
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5923
Practice Address - Country:US
Practice Address - Phone:714-477-8190
Practice Address - Fax:714-477-8191
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2025-11-12
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Provider Licenses
StateLicense IDTaxonomies
CAA85575207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABQ687YMedicare PIN