Healthcare Provider Details

I. General information

NPI: 1770421299
Provider Name (Legal Business Name): KELLI L. LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73450 COUNTRY CLUB DR SPC 50
PALM DESERT CA
92260-8678
US

IV. Provider business mailing address

73450 COUNTRY CLUB DR SPC 50
PALM DESERT CA
92260-8678
US

V. Phone/Fax

Practice location:
  • Phone: 760-333-3313
  • Fax:
Mailing address:
  • Phone: 760-333-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number61033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: