Healthcare Provider Details

I. General information

NPI: 1356186423
Provider Name (Legal Business Name): CECILIA TSAI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/28/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23119 SOBOBA RD
SAN JACINTO CA
92583-2903
US

IV. Provider business mailing address

10191 DECIMA DR
WESTMINSTER CA
92683-7047
US

V. Phone/Fax

Practice location:
  • Phone: 951-654-0803
  • Fax:
Mailing address:
  • Phone: 949-365-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: