Healthcare Provider Details

I. General information

NPI: 1215874789
Provider Name (Legal Business Name): MRS. ELISA L KUPHALDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3738 WALNUT AVE
CARMICHAEL CA
95608-3099
US

IV. Provider business mailing address

8441 RANCHITA WAY
FAIR OAKS CA
95628-6122
US

V. Phone/Fax

Practice location:
  • Phone: 916-971-7700
  • Fax:
Mailing address:
  • Phone: 916-971-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number3322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: