Provider Demographics
NPI:1578922118
Name:MEKEL, ELITE
Entity Type:Individual
Prefix:
First Name:ELITE
Middle Name:
Last Name:MEKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6596 OAK SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-3828
Mailing Address - Country:US
Mailing Address - Phone:818-590-2450
Mailing Address - Fax:
Practice Address - Street 1:3701 WILSHIRE BLVD STE 600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2814
Practice Address - Country:US
Practice Address - Phone:323-361-3550
Practice Address - Fax:323-361-8052
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1122300000X
CA1023031223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program