Healthcare Provider Details

I. General information

NPI: 1942631429
Provider Name (Legal Business Name): NATALIE SUSAN DAO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE SUSAN LEW PA-C

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 MILLIKEN AVE SUITE 310
RANCHO CUCAMONGA CA
91730-6780
US

IV. Provider business mailing address

5054 SAGEWOOD DR
RANCHO CUCAMONGA CA
91739-5138
US

V. Phone/Fax

Practice location:
  • Phone: 909-944-3797
  • Fax:
Mailing address:
  • Phone: 617-686-5870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: