Provider Demographics
NPI:1215329099
Name:ELLO, DALE TUGONON (NP-C)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:TUGONON
Last Name:ELLO
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 PEACH DRIVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068
Mailing Address - Country:US
Mailing Address - Phone:214-618-1804
Mailing Address - Fax:214-618-1804
Practice Address - Street 1:8027 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:NILAND
Practice Address - State:CA
Practice Address - Zip Code:92257-2630
Practice Address - Country:US
Practice Address - Phone:760-359-0110
Practice Address - Fax:760-359-3629
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX719953363LF0000X
CA95000535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily