Healthcare Provider Details

I. General information

NPI: 1003533837
Provider Name (Legal Business Name): DUYEN CAO MEDICAL STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 AMERICAN PACIFIC DR
HENDERSON NV
89014-8800
US

IV. Provider business mailing address

874 AMERICAN PACIFIC DR
HENDERSON NV
89014-8800
US

V. Phone/Fax

Practice location:
  • Phone: 702-777-8687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: