Healthcare Provider Details

I. General information

NPI: 1881283240
Provider Name (Legal Business Name): LOAN QUYNH CAO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 11/13/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W WEST COVINA PKWY STE 102
WEST COVINA CA
91790-2708
US

IV. Provider business mailing address

4145 EVART ST
MONTCLAIR CA
91763-3510
US

V. Phone/Fax

Practice location:
  • Phone: 626-856-2248
  • Fax:
Mailing address:
  • Phone: 909-510-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95014265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: