Healthcare Provider Details

I. General information

NPI: 1598513699
Provider Name (Legal Business Name): NATHAN CAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8230 LEESBURG PIKE STE 740
VIENNA VA
22182-2641
US

IV. Provider business mailing address

1120 BROOK VALLEY LN
MC LEAN VA
22102-1512
US

V. Phone/Fax

Practice location:
  • Phone: 877-504-4141
  • Fax:
Mailing address:
  • Phone: 703-589-5581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: