Healthcare Provider Details

I. General information

NPI: 1649939216
Provider Name (Legal Business Name): CHRISTIAN REY CAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 E GRAND AVE
POMONA CA
91766-3349
US

IV. Provider business mailing address

228 E GRAND AVE
POMONA CA
91766-3349
US

V. Phone/Fax

Practice location:
  • Phone: 626-465-6804
  • Fax:
Mailing address:
  • Phone: 626-465-6804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberS3C6R8A5
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: