Healthcare Provider Details

I. General information

NPI: 1396562856
Provider Name (Legal Business Name): ALEXANDRA MAY CAO PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 BUSINESS CENTER DR # 250
IRVINE CA
92612-1001
US

IV. Provider business mailing address

17595 HARVARD AVE STE C-968
IRVINE CA
92614-8516
US

V. Phone/Fax

Practice location:
  • Phone: 562-541-8950
  • Fax:
Mailing address:
  • Phone: 949-231-7219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95032017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: