Basic Information
| Provider Information | |||||||||
| NPI: | 1255539912 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALE | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RNC APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9477 RESERVE DR | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928839254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512770318 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3505 CADILLAC AVE | ||||||||
| Address2: | SUITE N-2 | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926261429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149795680 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2007 | ||||||||
| LastUpdateDate: | 08/07/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 132700000X | 385488 | CA | Y | Dietary & Nutritional Service Providers | Dietary Manager |
No ID Information.