Healthcare Provider Details

I. General information

NPI: 1730962226
Provider Name (Legal Business Name): ELENA LACLE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 N COURT ST
VISALIA CA
93291-4913
US

IV. Provider business mailing address

2292 ANDERSON AVE
TULARE CA
93274-1720
US

V. Phone/Fax

Practice location:
  • Phone: 559-754-3011
  • Fax:
Mailing address:
  • Phone: 559-362-7926
  • 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 StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: