Healthcare Provider Details

I. General information

NPI: 1285384867
Provider Name (Legal Business Name): CONNIE DAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9308 VALLEY BLVD
ROSEMEAD CA
91770-1924
US

IV. Provider business mailing address

PO BOX 7714
ALHAMBRA CA
91802-7714
US

V. Phone/Fax

Practice location:
  • Phone: 626-288-8881
  • Fax: 626-288-6648
Mailing address:
  • Phone: 626-202-3469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95018420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: