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General NPI Number Information
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NPI Number | 1538719976
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Entity Type | Individual
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Provider Name | NICHOLAS CAO PTA
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Gender | Male
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 2650 E IMPERIAL HWY STE 207
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City | BREA
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State | CA
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Zip | 92821-6103
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Country | US
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Telephone | 310-808-3753
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 W TOSCANINI DR
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-1837
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Country | US
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Telephone | 310-831-0962
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA50161
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License Number State | CA
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