Healthcare Provider Details

I. General information

NPI: 1568200665
Provider Name (Legal Business Name): MARY CAO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E HUNTINGTON DR
ARCADIA CA
91006-3748
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 626-462-1884
  • Fax: 626-445-1542
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: