Organization
ELITE SURGICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY POLIQUIN (OFFICE MGR)
(949) 722-7662
Entity
Organization
Contact information
Practice address
496 OLD NEWPORT BLVD STE 6, NEWPORT BEACH, CA 92663-4264
(949) 722-7662
(949) 631-6585
Mailing address
496 OLD NEWPORT BLVD STE 6, NEWPORT BEACH, CA 92663-4264
(949) 722-7662
(949) 631-6585
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
03/16/2018
Last updated
03/16/2018
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