Provider Demographics
NPI:1457020760
Name:SAINT ELIAS MEDICAL GROUP
Entity Type:Organization
Organization Name:SAINT ELIAS MEDICAL GROUP
Other - Org Name:ELITE FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHER
Authorized Official - Middle Name:I
Authorized Official - Last Name:DANHASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-498-6293
Mailing Address - Street 1:1183 E FOOTHILL BLVD STE 135
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4082
Mailing Address - Country:US
Mailing Address - Phone:909-498-6293
Mailing Address - Fax:
Practice Address - Street 1:1183 E FOOTHILL BLVD STE 135
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4082
Practice Address - Country:US
Practice Address - Phone:909-498-6293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty