Healthcare Provider Details

I. General information

NPI: 1376365841
Provider Name (Legal Business Name): KALIA CALIX NARCISO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 W GRAHAM AVE STE 106
LAKE ELSINORE CA
92530-3665
US

IV. Provider business mailing address

39800 RORIPAUGH RD
TEMECULA CA
92591-6117
US

V. Phone/Fax

Practice location:
  • Phone: 888-638-8457
  • Fax:
Mailing address:
  • Phone: 805-407-8278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: