Healthcare Provider Details

I. General information

NPI: 1568116127
Provider Name (Legal Business Name): KAITLIN MICHELLE NORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41307 12TH ST W STE 105
PALMDALE CA
93551-1454
US

IV. Provider business mailing address

41307 12TH ST W STE 105
PALMDALE CA
93551-1454
US

V. Phone/Fax

Practice location:
  • Phone: 323-313-9008
  • Fax:
Mailing address:
  • Phone: 323-313-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: