Provider Demographics
NPI:1255539912
Name:GALE, CAROLYN D (RNC APRN)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:D
Last Name:GALE
Suffix:
Gender:F
Credentials:RNC APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9477 RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-9254
Mailing Address - Country:US
Mailing Address - Phone:951-277-0318
Mailing Address - Fax:
Practice Address - Street 1:3505 CADILLAC AVE
Practice Address - Street 2:SUITE N-2
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1429
Practice Address - Country:US
Practice Address - Phone:714-979-5680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385488132700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes132700000XDietary & Nutritional Service ProvidersDietary Manager