Provider Demographics
NPI:1508022435
Name:ELITECARE SURGICAL GROUP, INC
Entity Type:Organization
Organization Name:ELITECARE SURGICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-233-2853
Mailing Address - Street 1:207 S SANTA ANITA ST
Mailing Address - Street 2:G18
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1146
Mailing Address - Country:US
Mailing Address - Phone:626-233-2853
Mailing Address - Fax:626-626-7773
Practice Address - Street 1:207 S SANTA ANITA ST
Practice Address - Street 2:G18
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1146
Practice Address - Country:US
Practice Address - Phone:626-233-2853
Practice Address - Fax:626-626-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82405208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty