1235015785 NPI number — ELITE INTERVENTIONAL RADIOLOGY CONSULTANTS OF CALIFORNIA PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235015785 NPI number — ELITE INTERVENTIONAL RADIOLOGY CONSULTANTS OF CALIFORNIA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE INTERVENTIONAL RADIOLOGY CONSULTANTS OF CALIFORNIA PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235015785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12421 SW SHERI AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE SUZY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34269-5938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26730 CROWN VALLEY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-6364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-364-2201
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2025

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
JACLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE ADMINISTRATOR
Authorized Official Telephone Number:
727-480-2734

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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