Individual
TRACEY S. PAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.P.N.P.
Contact information
Practice address
11370 ANDERSON ST STE 2100, LOMA LINDA, CA 92354-3450
(909) 558-2822
Mailing address
FILE # 54701, LOS ANGELES, CA 90074-4701
(909) 558-3111
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
NP 19497
CA
Other
Enumeration date
07/23/2010
Last updated
07/23/2010
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