Provider Demographics
NPI:1881283240
Name:CAO, LOAN QUYNH (NP)
Entity type:Individual
Prefix:MISS
First Name:LOAN
Middle Name:QUYNH
Last Name:CAO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 EVART ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-3510
Mailing Address - Country:US
Mailing Address - Phone:909-510-3329
Mailing Address - Fax:
Practice Address - Street 1:1500 W WEST COVINA PKWY STE 102
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2708
Practice Address - Country:US
Practice Address - Phone:626-856-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95014265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily