Provider Demographics
NPI:1710532015
Name:BRACE, ZOANNE VANETTE
Entity Type:Individual
Prefix:
First Name:ZOANNE
Middle Name:VANETTE
Last Name:BRACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39340 GAINSBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4022
Mailing Address - Country:US
Mailing Address - Phone:661-266-4548
Mailing Address - Fax:
Practice Address - Street 1:39340 GAINSBOROUGH DR
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4022
Practice Address - Country:US
Practice Address - Phone:661-266-4548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist