Provider Demographics
NPI:1457801300
Name:ELITE ENT
Entity Type:Organization
Organization Name:ELITE ENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:VAZQUEZ MD
Authorized Official - Suffix:
Authorized Official - Credentials:JANNET DE CARDENAS
Authorized Official - Phone:602-863-1716
Mailing Address - Street 1:2340 E BEARDSLEY RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1285
Mailing Address - Country:US
Mailing Address - Phone:602-802-8240
Mailing Address - Fax:602-802-8245
Practice Address - Street 1:2340 E BEARDSLEY RD
Practice Address - Street 2:SUITE 260
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-1285
Practice Address - Country:US
Practice Address - Phone:602-802-8240
Practice Address - Fax:602-802-8245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty