Healthcare Provider Details

I. General information

NPI: 1508752981
Provider Name (Legal Business Name): JONATHAN ALEX CAO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12222 MERIT DR STE 600
DALLAS TX
75251-3294
US

IV. Provider business mailing address

PO BOX 840853
DALLAS TX
75284-0853
US

V. Phone/Fax

Practice location:
  • Phone: 972-715-5000
  • Fax: 972-715-9976
Mailing address:
  • Phone: 972-233-1999
  • Fax: 972-233-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1009984
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: