Provider Demographics
NPI:1790827830
Name:DALE, GRACE (CPNP, MSN)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:
Last Name:DALE
Suffix:
Gender:F
Credentials:CPNP, MSN
Other - Prefix:MS
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:TZENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP, MSN
Mailing Address - Street 1:1801 MARENGO ST
Mailing Address - Street 2:GENERAL LAB BUILDING, ROOM 1G1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1365
Mailing Address - Country:US
Mailing Address - Phone:323-640-6525
Mailing Address - Fax:
Practice Address - Street 1:1801 MARENGO ST
Practice Address - Street 2:GENERAL LAB BUILDING, ROOM 1G1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1365
Practice Address - Country:US
Practice Address - Phone:323-640-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF 13442363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics