Provider Demographics
NPI:1942990718
Name:ELITE IMAGING GROUP
Entity Type:Organization
Organization Name:ELITE IMAGING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTRIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-625-9428
Mailing Address - Street 1:915 JUNIPERO DR
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-3712
Mailing Address - Country:US
Mailing Address - Phone:626-625-9428
Mailing Address - Fax:626-608-9111
Practice Address - Street 1:915 JUNIPERO DR
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3712
Practice Address - Country:US
Practice Address - Phone:626-625-9428
Practice Address - Fax:626-608-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile