Healthcare Provider Details

I. General information

NPI: 1548082357
Provider Name (Legal Business Name): CAROLYN DAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CENTENNIAL WAY
TUSTIN CA
92780-3714
US

IV. Provider business mailing address

315 CENTENNIAL WAY
TUSTIN CA
92780-3714
US

V. Phone/Fax

Practice location:
  • Phone: 949-250-1101
  • Fax: 949-250-1103
Mailing address:
  • Phone: 949-250-1101
  • Fax: 949-250-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: