Healthcare Provider Details

I. General information

NPI: 1558279141
Provider Name (Legal Business Name): ELIZABETH KATHRYN LACEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 MANHATTAN BEACH BLVD
MANHATTAN BEACH CA
90266-4941
US

IV. Provider business mailing address

520 SEA LN
LA JOLLA CA
92037-5444
US

V. Phone/Fax

Practice location:
  • Phone: 323-364-8898
  • Fax:
Mailing address:
  • Phone: 858-736-1376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: