Healthcare Provider Details

I. General information

NPI: 1558295196
Provider Name (Legal Business Name): KARA LINN MACE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 AVENUE E
REDONDO BEACH CA
90277-5088
US

IV. Provider business mailing address

219 AVENUE E
REDONDO BEACH CA
90277-5088
US

V. Phone/Fax

Practice location:
  • Phone: 424-392-2511
  • Fax:
Mailing address:
  • Phone: 424-392-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: