Healthcare Provider Details

I. General information

NPI: 1417363391
Provider Name (Legal Business Name): RACHAEL CAYCE, M.D. INC., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 10/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 WILSHIRE BLVD STE 909
LOS ANGELES CA
90017-3910
US

IV. Provider business mailing address

1127 WILSHIRE BLVD STE 909
LOS ANGELES CA
90017-3910
US

V. Phone/Fax

Practice location:
  • Phone: 214-278-0021
  • Fax: 214-278-0973
Mailing address:
  • Phone: 213-278-0021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA127822
License Number StateCA

VIII. Authorized Official

Name: RACHAEL LYNN CAYCE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 214-499-8343