Provider Demographics
NPI:1730794124
Name:ELITE PHYSICIANS GROUP PC
Entity type:Organization
Organization Name:ELITE PHYSICIANS GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-538-2295
Mailing Address - Street 1:2372 SE BRISTOL ST STE B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0755
Mailing Address - Country:US
Mailing Address - Phone:888-975-3246
Mailing Address - Fax:
Practice Address - Street 1:2372 SE BRISTOL ST STE B
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0755
Practice Address - Country:US
Practice Address - Phone:888-975-3246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty