Provider Demographics
NPI:1821178856
Name:ELITE DIAGNOSTIC IMAGING, LLC
Entity Type:Organization
Organization Name:ELITE DIAGNOSTIC IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-843-2900
Mailing Address - Street 1:17260 BEAR VALLEY RD
Mailing Address - Street 2:SIUTE 112
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7777
Mailing Address - Country:US
Mailing Address - Phone:760-843-2900
Mailing Address - Fax:760-843-0144
Practice Address - Street 1:17260 BEAR VALLEY RD
Practice Address - Street 2:SUITE 109
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7777
Practice Address - Country:US
Practice Address - Phone:760-843-2900
Practice Address - Fax:760-843-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200432110020174400000X
261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty