Provider Demographics
NPI:1851622328
Name:ELITE DIAGNOSTICS I INC
Entity Type:Organization
Organization Name:ELITE DIAGNOSTICS I INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:954-862-1432
Mailing Address - Street 1:18459 PINES BLVD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1400
Mailing Address - Country:US
Mailing Address - Phone:954-862-1432
Mailing Address - Fax:954-862-1437
Practice Address - Street 1:18459 PINES BLVD
Practice Address - Street 2:SUITE 119
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1400
Practice Address - Country:US
Practice Address - Phone:954-862-1432
Practice Address - Fax:954-862-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-24
Last Update Date:2010-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory