Healthcare Provider Details

I. General information

NPI: 1295726768
Provider Name (Legal Business Name): VICTORIA S PAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19842 LAKE CHABOT RD
CASTRO VALLEY CA
94546-4002
US

IV. Provider business mailing address

20055 LAKE CHABOT RD SUITE 340
CASTRO VALLEY CA
94546-5331
US

V. Phone/Fax

Practice location:
  • Phone: 510-537-1577
  • Fax: 510-537-1436
Mailing address:
  • Phone: 510-537-1577
  • Fax: 510-537-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA70717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: