Healthcare Provider Details

I. General information

NPI: 1285377192
Provider Name (Legal Business Name): MS. KAYCIE LYNN ELSASS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35325 DATE PALM DR STE 153F
CATHEDRAL CITY CA
92234-7086
US

IV. Provider business mailing address

35325 DATE PALM DR STE 153F
CATHEDRAL CITY CA
92234-7086
US

V. Phone/Fax

Practice location:
  • Phone: 937-507-5816
  • Fax:
Mailing address:
  • Phone: 760-537-1258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberL9698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: