Provider Demographics
NPI:1942829346
Name:ELITE MD
Entity Type:Organization
Organization Name:ELITE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-299-3110
Mailing Address - Street 1:3349 SOLENTO LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-1735
Mailing Address - Country:US
Mailing Address - Phone:818-299-3110
Mailing Address - Fax:
Practice Address - Street 1:2855 S BRONCO ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5207
Practice Address - Country:US
Practice Address - Phone:702-730-0926
Practice Address - Fax:702-926-9658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty