Healthcare Provider Details

I. General information

NPI: 1710728696
Provider Name (Legal Business Name): MADELYN E LOREI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41990 COOK ST STE H701
PALM DESERT CA
92211-6103
US

IV. Provider business mailing address

41990 COOK ST STE H701
PALM DESERT CA
92211-6103
US

V. Phone/Fax

Practice location:
  • Phone: 760-327-7900
  • Fax:
Mailing address:
  • Phone: 760-327-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number64793
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085010221
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2024011261
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: