Healthcare Provider Details

I. General information

NPI: 1447603857
Provider Name (Legal Business Name): MINDY DANG CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15700 S WESTERN AVE
GARDENA CA
90247-3702
US

IV. Provider business mailing address

15700 S WESTERN AVE
GARDENA CA
90247-3702
US

V. Phone/Fax

Practice location:
  • Phone: 310-538-3131
  • Fax:
Mailing address:
  • Phone: 310-538-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH67270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: