Provider Demographics
NPI:1881241727
Name:ELITE PEDIATRICS PLLC
Entity type:Organization
Organization Name:ELITE PEDIATRICS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-412-9361
Mailing Address - Street 1:137 ZAMORA MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5485
Mailing Address - Country:US
Mailing Address - Phone:830-758-7621
Mailing Address - Fax:
Practice Address - Street 1:137 ZAMORA MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5485
Practice Address - Country:US
Practice Address - Phone:830-758-7621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty