Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 15142 | CA |
NPI | 1023193570 |
---|---|
Provider Name | Veronica Irene Dale |
First Address | Canoga Park, CA 91303-4255 |
Second Address | Canoga Park, CA 91303-4255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 14/12/2011 |