Provider Demographics
NPI:1487366787
Name:DE LACY, ALEXIS TAYLOR (DO)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:TAYLOR
Last Name:DE LACY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:TAYLOR
Other - Last Name:MARTIN-ENTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1150 N INDIAN CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4872
Mailing Address - Country:US
Mailing Address - Phone:760-323-6511
Mailing Address - Fax:
Practice Address - Street 1:1150 N INDIAN CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4872
Practice Address - Country:US
Practice Address - Phone:760-323-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program