Healthcare Provider Details

I. General information

NPI: 1194239228
Provider Name (Legal Business Name): DAVID M CAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12900 PALM DR
DESERT HOT SPRINGS CA
92240-4567
US

IV. Provider business mailing address

1 BROOKSIDE AVE
WORCESTER MA
01602-1609
US

V. Phone/Fax

Practice location:
  • Phone: 760-251-3866
  • Fax:
Mailing address:
  • Phone: 508-335-1127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: