Healthcare Provider Details

I. General information

NPI: 1003129842
Provider Name (Legal Business Name): MICHELLE CAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 FLETCHER PKWY SUITE 105
LA MESA CA
91942-3134
US

IV. Provider business mailing address

8881 FLETCHER PKWY SUITE 105
LA MESA CA
91942-3134
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2600
  • Fax: 619-462-9625
Mailing address:
  • Phone: 858-499-2600
  • Fax: 619-462-9625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA113677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: