Provider Demographics
NPI:1134829955
Name:ELITE MEDICAL CONSULTS
Entity type:Organization
Organization Name:ELITE MEDICAL CONSULTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PINLAC
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:602-341-3392
Mailing Address - Street 1:2906 E UNION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3430
Mailing Address - Country:US
Mailing Address - Phone:602-341-3392
Mailing Address - Fax:
Practice Address - Street 1:6123 S RAINBOW BLVD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3253
Practice Address - Country:US
Practice Address - Phone:602-341-3392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty