Provider Demographics
NPI:1821268244
Name:DEGALA, GRACE YAMSUAN
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:YAMSUAN
Last Name:DEGALA
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 1:1113 MOONLIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6225
Mailing Address - Country:US
Mailing Address - Phone:650-888-3538
Mailing Address - Fax:
Practice Address - Street 1:1113 MOONLIGHT WAY
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6225
Practice Address - Country:US
Practice Address - Phone:650-888-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator