Provider Demographics
NPI:1689241457
Name:ELITE PHYSIOLOGY, INC.
Entity Type:Organization
Organization Name:ELITE PHYSIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:CAPOZZIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCN, BCB, CMT
Authorized Official - Phone:415-854-3444
Mailing Address - Street 1:14 PRECITA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4619
Mailing Address - Country:US
Mailing Address - Phone:415-854-3444
Mailing Address - Fax:
Practice Address - Street 1:14 PRECITA AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4619
Practice Address - Country:US
Practice Address - Phone:415-854-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service