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DALE TIGLAO BALILO RN
Psychiatric/Mental Health >> Registered Nurse >> Nursing Service ProvidersRegistrant NPI Number: 1649855404
Individual Registrant: DALE TIGLAO BALILO RN
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
6108 BLACKTHORNE AVE LAKEWOOD, CA 90712-1118 US
Tel: 619-218-8681 Fax: --
Tel: 619-218-8681 Fax: --
Contact information for business:
6108 BLACKTHORNE AVE LAKEWOOD, CA 90712-1118 US
Tel: 619-218-8681 Fax: --
Tel: 619-218-8681 Fax: --
Registration Information:
NPI: 1649855404
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 163WP0808X | Nursing Service Providers Registered Nurse Psychiatric/Mental Health | CA | 95160322 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| CALIFORNIA REAL ID/DRIVER'S LICENSE | D2928760 | CA | 01 |
