Healthcare Provider Details

I. General information

NPI: 1053774505
Provider Name (Legal Business Name): LISA ANN CAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR STE 508
ORANGE CA
92868-3856
US

IV. Provider business mailing address

1310 W STEWART DR STE 508
ORANGE CA
92868-3856
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-2111
  • Fax: 844-387-7625
Mailing address:
  • Phone: 714-633-2111
  • Fax: 844-387-7625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA154455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: