Provider Demographics
NPI:1942631429
Name:DAO, NATALIE SUSAN (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:SUSAN
Last Name:DAO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:SUSAN
Other - Last Name:LEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5054 SAGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-5138
Mailing Address - Country:US
Mailing Address - Phone:617-686-5870
Mailing Address - Fax:
Practice Address - Street 1:7777 MILLIKEN AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6780
Practice Address - Country:US
Practice Address - Phone:909-944-3797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51561363A00000X
MI5601006261363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant