Provider Demographics
NPI:1134647068
Name:ELITE MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:ELITE MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:NESSA
Authorized Official - Last Name:NEJAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-612-3656
Mailing Address - Street 1:2667 CAMINO DEL RIO S STE 315
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3765
Mailing Address - Country:US
Mailing Address - Phone:619-629-0248
Mailing Address - Fax:619-393-0328
Practice Address - Street 1:2667 CAMINO DEL RIO S STE 315
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3765
Practice Address - Country:US
Practice Address - Phone:619-629-0248
Practice Address - Fax:619-393-0328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies