Individual
DALE TIGLAO BALILO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
6108 BLACKTHORNE AVE, LAKEWOOD, CA 90712-1118
(619) 218-8681
Mailing address
6108 BLACKTHORNE AVE, LAKEWOOD, CA 90712-1118
(619) 218-8681
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95160322
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D2928760
CALIFORNIA REAL ID/DRIVER'S LICENSE
CA
Enumeration date
03/13/2021
Last updated
03/13/2021
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