Healthcare Provider Details

I. General information

NPI: 1932718996
Provider Name (Legal Business Name): MATTHEW CAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date: 07/11/2025
Reactivation Date: 08/15/2025

III. Provider practice location address

3820 BEACON POINT ST
LAS VEGAS NV
89129-8303
US

IV. Provider business mailing address

3820 BEACON POINT ST
LAS VEGAS NV
89129-8303
US

V. Phone/Fax

Practice location:
  • Phone: 702-722-7641
  • Fax:
Mailing address:
  • Phone: 702-722-7641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12400-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: