Healthcare Provider Details

I. General information

NPI: 1710054036
Provider Name (Legal Business Name): MARY REI-CHI TAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 THE CITY DR S
ORANGE CA
92868-3205
US

IV. Provider business mailing address

615 WEST RD
LA HABRA HEIGHTS CA
90631-8077
US

V. Phone/Fax

Practice location:
  • Phone: 714-567-7387
  • Fax:
Mailing address:
  • Phone: 562-694-6106
  • Fax: 562-694-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics
License NumberA70229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: