Provider Demographics
NPI:1083019830
Name:ELITE NEUROLOGY OF ORANGE COUNTY, INC.
Entity Type:Organization
Organization Name:ELITE NEUROLOGY OF ORANGE COUNTY, INC.
Other - Org Name:ELITE NEUROLOGY OF ORANGE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-202-0218
Mailing Address - Street 1:2617 E CHAPMAN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3251
Mailing Address - Country:US
Mailing Address - Phone:714-202-0218
Mailing Address - Fax:
Practice Address - Street 1:2617 E CHAPMAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3251
Practice Address - Country:US
Practice Address - Phone:714-202-0218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG811952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1083019830OtherGROUP NPI
CA1841210846OtherNPI
CAG81195OtherMEDICAL BOARD OF CA
CA1083019830OtherGROUP NPI