Healthcare Provider Details

I. General information

NPI: 1982162863
Provider Name (Legal Business Name): ROBERT VU CAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2019
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10707 LAUREN CIR
GARDEN GROVE CA
92840-5012
US

IV. Provider business mailing address

10707 LAUREN CIR
GARDEN GROVE CA
92840-5012
US

V. Phone/Fax

Practice location:
  • Phone: 714-478-4074
  • Fax:
Mailing address:
  • Phone: 714-478-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA56641
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number56641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: