Healthcare Provider Details

I. General information

NPI: 1881707222
Provider Name (Legal Business Name): DIANA T CAO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRANGDAI T. CAO DOCTOR OF PHARMACY

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/19/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 BENTON ST
LOMA LINDA CA
92357-1000
US

IV. Provider business mailing address

11201 BENTON ST
LOMA LINDA CA
92357-1000
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax: 909-777-3208
Mailing address:
  • Phone: 909-825-7084
  • Fax: 909-777-3208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number52118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: