Healthcare Provider Details

I. General information

NPI: 1154966091
Provider Name (Legal Business Name): MARA TA CAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 VALENCIA STREET LEVEL 3
SAN FRANCISCO CA
94110
US

IV. Provider business mailing address

1580 VALENCIA ST
SAN FRANCISCO CA
94110-4423
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-5400
  • Fax: 415-369-1397
Mailing address:
  • Phone: 415-600-5400
  • Fax: 415-369-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA194823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: