| Elite Family Medical Center | |
|
1183 E Foothill Blvd Ste 135 Upland CA 91786-4082 | |
| (909) 498-6293 | |
| Not Available |
| Full Name | Elite Family Medical Center |
|---|---|
| Speciality | Family Medicine |
| Location | 1183 E Foothill Blvd Ste 135, Upland, California |
| Authorized Official Name and Position | Maher I Danhash (OWNER) |
| Authorized Official Contact | 9094986293 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Family Medical Center 1183 E Foothill Blvd Ste 135 Upland CA 91786-4082 Ph: (909) 498-6293 | Elite Family Medical Center 1183 E Foothill Blvd Ste 135 Upland CA 91786-4082 Ph: (909) 498-6293 |
| NPI Number | 1457020760 |
|---|---|
| Provider Enumeration Date | 09/09/2021 |
| Last Update Date | 10/20/2021 |
| Certification Date | 10/20/2021 |
| Medicare PECOS PAC ID | 2567856438 |
|---|---|
| Medicare Enrollment ID | O20220219000051 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457020760 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (NU) | Secondary |
| 207Q00000X | Family Medicine | (NU) | Primary |
| Provider Name | Maher Danhash |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689993313 PECOS PAC ID: 5597993097 Enrollment ID: I20140108000361 |
| Provider Name | Pamela Ann Mack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881309045 PECOS PAC ID: 5799222683 Enrollment ID: I20250717001587 |
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