MEDICARE: DIANE BAO PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	58802	CA

General Provider Information

NPI Number	:	1407952088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE BAO PHARM.D.

Provider Business Mailing Address
First Line	:	PO BOX 573
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-0573
Country	:	US
Telephone Number	:	562-598-2939
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 PACIFIC COAST HWY
Second Line	:
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-3509
Country	:	US
Telephone Number	:	562-240-3800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	08/30/2007

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