Healthcare Provider Details

I. General information

NPI: 1497205462
Provider Name (Legal Business Name): TAWNIE THAO CAO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 N BELLFLOWER BLVD
LONG BEACH CA
90815-3126
US

IV. Provider business mailing address

2110 N BELLFLOWER BLVD
LONG BEACH CA
90815-3126
US

V. Phone/Fax

Practice location:
  • Phone: 562-346-2222
  • Fax:
Mailing address:
  • Phone: 562-346-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA55461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: