MEDICARE: CHRISTIAN REY CAO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	202K00000X	Phlebology Physician	S3C6R8A5	CA

General Provider Information

NPI Number	:	1649939216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN REY CAO

Provider Business Mailing Address
First Line	:	228 E GRAND AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91766-3349
Country	:	US
Telephone Number	:	626-465-6804
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 E GRAND AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91766-3349
Country	:	US
Telephone Number	:	626-465-6804
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2021
Last Update Date	:	12/10/2021

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Directions to “ CHRISTIAN REY CAO ” Practice Location

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