Healthcare Provider Details

I. General information

NPI: 1841467891
Provider Name (Legal Business Name): MRS. ELIZABETH ANN COLUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6722 WHITE FEATHER RD
JOSHUA TREE CA
92252-6605
US

IV. Provider business mailing address

57854 BELMONT ST
YUCCA VALLEY CA
92284-8620
US

V. Phone/Fax

Practice location:
  • Phone: 760-365-6909
  • Fax:
Mailing address:
  • Phone: 760-365-6909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: