Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A113677 | CA |
NPI | 1003129842 |
---|---|
Provider Name | Dr. Michelle Cao |
First Address | La Mesa, CA 91942-3134 |
Second Address | La Mesa, CA 91942-3134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2010 |
Last Update Date | 07/10/2020 |