Provider Demographics
NPI:1417363391
Name:RACHAEL CAYCE, M.D. INC., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:RACHAEL CAYCE, M.D. INC., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CAYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-499-8343
Mailing Address - Street 1:1127 WILSHIRE BLVD STE 909
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3910
Mailing Address - Country:US
Mailing Address - Phone:213-278-0021
Mailing Address - Fax:
Practice Address - Street 1:1127 WILSHIRE BLVD STE 909
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3910
Practice Address - Country:US
Practice Address - Phone:214-278-0021
Practice Address - Fax:214-278-0973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127822207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty