Provider Demographics
NPI:1467606632
Name:ELITE DIAGNOSTIC, LLC
Entity Type:Organization
Organization Name:ELITE DIAGNOSTIC, LLC
Other - Org Name:ELITE DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LANDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRALLEGRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-237-0999
Mailing Address - Street 1:PO BOX 27696
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92809-0123
Mailing Address - Country:US
Mailing Address - Phone:866-354-8968
Mailing Address - Fax:866-354-1115
Practice Address - Street 1:725 N SHEPARD ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2836
Practice Address - Country:US
Practice Address - Phone:866-354-8968
Practice Address - Fax:866-354-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)Group - Single Specialty